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Home My WebLink AboutBuilding PermitsTOWN OF YARMOUTH Building Department BUILDING r h (508) 398-2231 ext1261 ' PERMIT NO - m :: ; : 023 _ PROPOSED USE , u ISSUE DATE : _ 1129/2013 - ' APPLICANT Jason n o ".... JOB WEATHER CARD PERMIT TO Repair AT (LOCATION) 0311ROUTE 28 —� ZONING DISTRIC B2 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK F030 26 BUILDING IS TO BE: CONST TYPE 5•B USE GROUP R-3 LOT SIZE U Re -roof — 12 sqs. Stripping Old Shingles iRcMARKS _ - CONTRACTOR LICENSE CCS-066328 Major, Bill 40 Winter Street AREA (SO FT) EST COST ($ I$3,000.00 PERMIT FEE ($) $I 00, Bridgewater MA 02324 5085847223 OWNER ICARVALHO, JASON, TR BUILDING DEPT BY ADDRESS 0311ROUTE 28 E- PHONE 5085847223 IWESTYARMOUTH MA 021 673 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLUC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1) FOUNDATIONS OR FOOTINGS. 2) PRIOR TO COVERING STRUCTURAL MEMBERS (READY FOR LATH OR FINISH COVERING) 3) FINAL INSPECTION BEFORE OCCUPAUCY 4) REFER TO DETAILED INSPECTION SCHEDULE APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND REQUIRED, SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. OST THIS CARD SO IT IS VISIBLE FROM STREET 3 5 by rYyJ YY x '� I �2, r( I ,�'3��`3r'J'y�i�y'�''":��yi �"�M1��'�`•t L' xF,sy�y:r 2 2g��4<�f{ �53� {{g¢{l,a.t�^i. o{'$ ahC ?�"r 2 /r4i f�� xar,"t1 2Ti ti¢J {F �,Y ,s�� fr •�,,7. 3 OTHEQ77.q i r ? r by PO�ti �{'�{.aq*s,ay.,. 2 3 4Eq 5 WORK SHALL 140T PROCEED PERMIT WILL EECOME NULL AND VOID IF INSPECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORI: IS NOT STARTED WITHIN SIX CAN BE ARRANGED rOR BY TELEPHONE APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION ABOVE. OF Ir TOWN OF YARMOUTH Building Department ' j I 1 D I PERMIT NO 6-13-1023_ (508) 398-2231 ext.1261 �i 1�.. V PROPOSED USE I ISSUE DATE ; 112912013 ;. .e _ _ _ _ _ _ _ . _ _ APPLICANT Jason Carval....ho ............ JOB WEATHER CARD PERMIT TO Repair AT (LOCATION) 0311ROUTE 28 ZONING DISTRIC B2 Bldg. Type: Commercial SUBDIVISION MAP LOT BLOCK LOT SIZE Re -roof —12 sqs. Stripping Old Shingles REMARKS BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 AREA (SQ FT) EST COST ($ 53,000.00 PERMIT FEE ($) 375.00 OWNER ICARVALHO, JASON, TR BUILDING DEPT BY ADDRESS 1031111ROUTE28 WEST YARMOUTH MA 102673 YOUR SPECIAL ATTENTION Is called to the following: CONTRACTOR LICENSE CS 066328 Major, Bill - 40 Winter Street Bridgewater MA 02324 5085647223 PHONE 150851147223 This permit is granted on the express condition that the said construction shall, in all respects, conform to the Ordinances of this jurisdiction including the Zoning Ordinance, regulating the construction and use of buildings, and may be revoked at any time upon violation of any provisions of said ordinances. Weatherproof placard given at the time permit is issued must be displayed on premises. The Department must be notified and inspection made of prior construction work as requested on weather card. All new buildings and additions and alterations to existing buildings require a minimum of three called inspection, namely, 1) Footings, drain tile systems, foundation and basement walls, when walls are at least two feet high, but before back fillings the wall and before proceeding with the superstructures. 2) Framing prior to lath or finish covering but after firestopping, electrical, plumbing and mechanical systems are installed. 3) Final inspection when building or structure is completed. On jobs Involving reinforced concrete work, inspection must be made after steel Is in place and before concrete Is poured. The Department reserves the right to reject any work which has been concealed or completed without first having been Inspected and approved by the Department In accordance with the requirements of the various codes. Any deviation from the approved plans must be authorized by the approval of revised plans subject to the same procedure established for the examination of the original plans. An additional permit fee is also charged predicated on the extent of the variation from the original plans. Permits are not valid if construction work is not started within six months from date permit Is Issued. Request for Final Inspection should be made by postcard or phone call to this department when the construction work is completed and heating apparatus has been Installed. Painting or decorating is not required before the Final Building Inspection. Final Inspection and certificate of occupancy must be obtained before occupying buiding. APPLICANT COPY , OF 1 TOWN OF YARMOUTH Building Department I LD I PERMIT NO 6-13-1023 (508) 398-2231 ext.1261 d- _ PROPOSED USE IT , ISSUE DATE ;. 1/29/2013 . ; APPLICANT _...C8.................... JOB WEATHER CARD PERMIT TO Repair AT (LOCATION) ZONING DISTRIC B2 Bldg. Type: Commercial 10311ROUTE28 SUBDIVISION MAP LOT BLOCK 1030.26 BUILDING IS TO BE: CONST TYPE 5-B USE GROUP R-3 LOT SIZE Re -roof —12 sqs. Stripping Old Shingles REMARKS AREA (SQ FT) EST COST ($ $3,000.00 PERMIT FEE ($) $75.00 OWNER ICARVALHO, JASON, TR BUILDING DEPT BY ADDRESS 10311 ROUTE 28 WESTYARMOUTH MA 02673 CONTRACTOR LICENSE CS-066328 Major, Bill 40 Winter Street Bridgewater MA 02324 5085847223 PHONE 150851147223 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector .YAR�o s N � Permit # � �3-�oa3 'FceS�_ Permit expires 6 months from , 1 issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 3I98-22331 Ext. 1261 �/� CONSTRUCTION ADDRESS: I s • l +-N 6- V/ . q tHz MOt tH ASSESSOR'S INFORMATION: ee rr ll Map: 030 Parcel: 2-4OWNER:4�]ON CNTLV ARC- 3S z)%Wa5l (&Lk< CONTRACTOR: -YAL I I d- O'La-L Lwf i�� yip, tcr.s 014- .... / ICj7� / G+�soF-5f/-� 72z3 ❑ Residential 4COmmercial ❑ Est. Cost of Construction S o ent or LI Construction Supervisor Workman's Compensation Insurance: c ❑ lam the homed I am the sole proprietor ❑ I have Worker's Compensation Insurance I / Insurance Company Nam l ' • b Worker's Comp. Policy# X WORK TO BE PERFORMED ❑ Teat (Fire Retardant CatiEcate attached) ❑ Wood Stove Shed ❑ Siding: # of Squares ❑ Replacement windows: # D Replacement doors: # ❑ Re -roof: # of Squares Stepping old shingles' *The debris will be disposed of at:� I declare under penalties of perjury will be just cause for denial or Applicant's. Signature: Owners Signature (or ❑ Insulation () going over layers of existing roof ❑ Old Kings Highwayalistoric District Roofing/Siding (L&c for Like) e statements herein contained are true sod correct to the best of my knowledge and belief, I understand that any false answer(s) of my license and fyrjprosMutiq$ under M.O.L Ch. 268, Section 1. Date: Approved By: Date: Building Official (or designee) Zoning District: 134'' 1, `to Historical District: ❑ Yes 4 No Flood Plain Zone; Y Yes Water Resource Protection District: Within 100 R of Wetlands: ❑ Yes XNo 'Yes ❑ • No ❑No Dl'71J U 15 JAN 2 9 2013 GUi:O NGDEPT • The Commonwealth ofMassaehusetis Department of Industrial Accidents Office of Investigations kv 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricinnt/Pir..,,ho..e k,l1Yi3Ia1etLIp: D1,1UUwAJNT M—M 11A)a Phone #' Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I mployees (full and/or part-time).' 2. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance reluire&] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 3 a. ❑ I am a homeowner acting as a general contractor (refer to #4) have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. (No workers' camp. insurance reauired.1 Q[-2,b4-?KIl_ Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.EfRoof repairs 13.❑ Other •Any applicant that checks box #i must also fill out the section below showing theirworkers' eompensatiAolicy information, t Homeowners who submit this affidavit indicating they are doing all wort and then hire outside conttacton must submit a new affidavit indicating such. t rontracwn that check this box must attached an additional sheet showing the nano of the sub-cooaacton and state whether or not those entities have employees. If the sub-contnctm have employees, they must provide their workers' comp. policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify 4Tf 1 f e pairs and penalties of perjury that the information provided above is true and correct Ofeial use only. Do not %rite in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employeiss to provide workers' compensation lot their employees. pursuant to this statute. an explgst is defined as %.every pesos in the service of another under any contract of his, express of implied, oral or written." An ssplsyw is defined as "an individual, puff= hip. sgsoctatiaa, corporation Or other legal entityv of sny two or more of the focegaiug engaged is a joint enterprise. sad including tot legal teptaeutstiva of a deceased employs; err the rrtMer cc trustee of as individual, pssEoashiP4 association a other legal entityo empbyin8 employees. However the owns of a dwelling home baying not more am three Ap•rEmeats and who resides thersino of the Occupant of rho dwelling house of autotba who employs persona to do mtinteaaace, construction or repair work an such dwelling bouse err as the grouada a burldmg sppurt mant thereto sball not because of such employment be deemed to be an employees" MGL chapter 152,125C(6) Also states that "every stab K' al Housing sgotey skater with[told the iguana or renewal of a &-sure or permit to operate a business or to construct buildings In dw amoawealti, for lay appileaat wbs hie not produced saeptable evidence of compass with the Insurance average required." Additionally. MGL chapter 1A Mn n states "Nr'dses the cammoswcalth eras any of its political subdivisions shall eater, into Any contract far the pertocmaaee of public work until acceptsbk evidence of compiisom with the insurance requirements of this chapter have been presented to the contracting authority." Applicants please fill out the worker' compensation affidavit completely, by checking the boxes that apply to your situsttm ate, if necessary, supply subcontrectos(s) name(s). tea) and pbOOe namber(s) tong with their eertiBeate(s) of murzom Limited Liablity Companies (LLQ at Limited Liability partnerships (LLP) with no employes other tom the members a partners. are not required to carry workero' comPenutim imur =- If m LLC a LLP does hays employeer4 s porky is required. Be advised that this a!$davit maybe submitted to the Department of hxhistrial Accident for confirmation of insurance coverage. Able be rye to alp and date this a1IIdav1L The affi aril should be retraced to the city or town that the application for the permit a li= is being requested. net the Departimest of Indus<sial Accidents._ Should you have any questions repeniiag the law or if you us yeti isod to obtain a mmkc:a' compensation polfery, please all the Department at the number listed below. Self-insaed caaspaniey hoald eater their- self-iataesnee House uaumI r on the app mpdsb lint. City or Taws Ot2<dab Please be sae that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be mre to till in tbo perms/license number which will be used as a mfaeneo nmabet. Ice additiM m applicant that most submit multiple perms applications in ray given year, need only submit one a®davit iodicamog current policy lnfflriiatka (ffneeessary) and unties "Job Sete Address" the appllaat should write "all locations in (city or town)." A copy *(the affidavit that ban been ofllcially d, ; - d or marlmd by the city a taws maybe provided to the applicant n proof that a valid affidavit is on file for Atture permits or licenses. A new affidavit tart be filled out cub year, wheat a home awou at citizen is obtaining s license at permit not related ter aay business at commercial vesture (Le. a dog license or permit to bras lea res etc.) said pawn is NOT required to compkts this affidavit The Office of Investigad= would like to thank you in adrtaee for your cooperation and should you have any questions, please do not hesitate to give m a aIL rise Deputment's address, telephone and far trrrmber: The Commonwealth of Mmuhusetb Department of Wusttial Accidents Oaks of Iavtstlptions 600 Washington Street Boston, MA 02111 Tel.11617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-224)6 Fax M 617-727-7749 www.mass.gov/dia • R-7 CERTIFICATE OF LIABILITY INSURANCE OPID CA DATE(MWDOlWYY) 03/19/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the po Icy les must be endOFSeEL If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemem(s). PRODUCER NAn1E: PHONE (C. No. Ext)- (A/C. No): Leonard Insurance Sery Agy Inc PO Box 9160 ADDRESS: CUSTOMERDS: JASO11-6 Canton ON 44711-9160 Phone:330-266-1904 Fax:330-498-9946 WSURER(S)AFFORDING COVERAGE NAIC0 INSURED 943URERA: Executive Risk Specialty 44792 Jason Carvalho 35 Boxwood Lane INSURER 8: INSURERC: Bridgewater 1 % 02324 INSURERD: INSURER E • . - , INSURER F t COVERAGES CERTIFICATE NUMBER: "' . REVISION NUMBER: THIS IS TO CERTIFY THAT THE PUIICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 04SUR'ED I"ED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIPUENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED ON MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM;. LTR TYPE OF PJSURA14CE INSR WV POLICY NUMBER (MM,DDlYYYY) I1,11,M)OYYYYI LIM"'S A GENERAL LVaUrr' X COMMERCIAL GENERAL LIABILITY X CLAJMS-MADE OCCUR X 822SI497 04/01/12 04/01/13 EACH OCCURRENCE j 1,000,000 PRE MISES(Ea occurrence) S MED EXP(Arty" person) S PERSONAL & ADV INJURY $1,000,000 X Et0 Liability GENERAL AGGREGATE $1,000,000 GENT Ai,REGATE LIMIT APPLIES PER. POLICY 7 �,R& LOC PHODUCTS- COMPIOP AGO. j j AUTOMOME LIABILrTY ANY AUTO All OWNED AUTOS SCI iEIXAED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBJED SINGLE LIMIT (Ea ectiderd) i BODILY INJURY(Per person) If BODILY INJURY (Per eccld,ri) $ PROFERTY DAMAGE (Per occidu%) j $ i UMBRELLA LIAR E%LESS LIAR CUR CTPJMSMADE EACH OCCURRENCE j AGGRLGATE $ DmIJCTIEJLE RETENTION f j j WORKERS1 .. .. AND EMPLOYERS' (LABILITY YIN ANY PckCPETORNARTNFRIEXECUTIVE ❑ OFFICEPJMEMEER EXCLUDED? (Mondelory In NH) '- It yes, descrte under DESCRIPTION OF OPERATIONSbelow 41A I - - - ( _ TORY LIMITS • -- ER - - - E.L. EACH ACCIDENT .j . E.L. DISEASE - EA EMPLOYEE E.L DISEASE -POLICY LIMIT , i DESCRIPTION OF OPERATIONS I LOCATION3I VEHICLES (Mach ACORD 101, Addhlornl Remar%a Schedule. IT mona span Is nQu►ed) Mortgage Field Services Certificate holder is additional insured per signed contract agreement CERTIFICATE HOLDER CANCELLATION Safeguard Properties 7887 Safeguard Circle (Hub Parkway) Valley View OH 44125-5742 SHOULD ANY OF THE ABOVE DESCRIBED POUCIE3 BE CANCELLED BEFORE SAFEF-1 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDA4CE WITH THE POLICY PROVISIONS. Darren J. Faye ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Details Ittp://cliccnse.clis. statc.im.us/NtrificadoWDctails.aspx?agency_id=1... The Official Websito of the Exectmee Office of Pubic Safety and Secuity(EOPSS) Mass.Gov Home State Agencies State Online SeMces Licensee Details Demographic Information, License Address Information Address 2: City: BRIGEWATER State: MA Zipcode: 02324 County: United States_ } License Information ifession: Building Licenses Date of Last Renewal: ue Date: 7/26/2011 Expiration Date: ense Status: Active Today's Date: condary License: ing Business As: Prerequisite Information construction 7/26/2013 1 /22/2013 No Prerequisite Information I . Discipline No Discipline Information Documentum close window ® 2011 Commonwealth of Massachusetts Site Policies Contact Us Site Ma IofI 1/22/2013 6:17 PM %� j�-� ,� r INVOICE NO. , V cf&. (v W , iwcT- 2 w-� —IiVi/OIC-E SOLD TO A,( L ,f}-ctrc.l SHIPPED TO VIA ADDRESS ADDRESS CITY, STATE, LP Al A- o v3ZLI CITY, STATE, ZIP CUSTOMER'S ORDER SALESPERSgN:.:',. '�' :+ d TERMS F,0.9.' DATE. �r Uop nl6 S ;,u A-T�� I,N f -it.A C GV r - tt r r7 L Z , �• i i i . j 4 wo 8740 Page 1 of 1 Cipro, Linda From: Sawyer, John Sent: Friday, January 04, 2013 5:45 PM To: Cipro, Linda; Murphy, Bruce; Renaud, Philip; Arnault, Andrew; Hail, Lee; Elliott, Ken; Armstrong, James; Simonian, Phillip; Walker, Michael Subject: RE: final for occupancy 0 311 Route 28 and 2 White's Path - bagels & beyond 311 Route 28 must have the hood fire suppression serviced before signoff. Two emergency lights did not work. 2 Whites Path has been signed off by YFD From: Cipro, Linda Sent: Friday, January 04, 2013 10:06 AM To: Murphy, Bruce; Renaud, Philip; Arnault, Andrew; Hall, Lee; Elliott, Ken; Armstrong, James; Sawyer, John; Simonlan, Phillip; Walker, Michael Subject: final for occupancy @ 311 Route 28 and 2 White's Path - bagels & beyond 01/04/13 The Building Department is scheduled to conduct a final for occupancy Inspection today 01/04/13 0 311 Route 28 and 2 White's Path — Bagel & Beyond and would like for you to attend. The contact person is Julie Moran and she can be reached at 508-790-8500. Please come to the Building Department to sign off on the Certificate of Occupancy or email your inspection approvals. Thanks, Linda Linda Cipro Principal Office Assistant Building Departinent IM2013 or r TOWN OF YARMOUTH Building Department BUILDING _ _ _ _ _ _ _ (508) 398-2231 ext.1261 --- 70 PERMIT NO B-11-870 - ' PROPOSED USE • . " .. PERMIT •• ISSUE DATE ; _ ....... _ ; ••---.....-•-•----- APPLICANT ,Brian Cave -- , JOB WEATHER CARD PERMIT TO Alterations ' AT (LOCATION) ISTRIC 82 Bldg. Type: Commercial 10311ROUTE28 SUBDIVISION MAP LOT BLOCK 1030.26 1 BUILDING IS TO BE: CONST TYPE USE GROUP LOT SIZE O REMARKS one replacement window AREA (SO FT) EST COST ($ $3,400.00 PERMIT FEE ($) $200.00 OWNER ICARVALHO, JASON, TR/Bagels 8 Beyond BUILDING DEPT BY ADDRESS 0311ROUTE28 —� West Yarmouth MA 102673 INSPECTION RECORD Date 7 Note Progress - Corrections and Remarks CONTRACTOR LICENSE 59791 Cave, Brian —71 — P.O. Box 1482 Middleboro MA 02346 5082087788 PHONE 50 22697912 FIELD COPY This Section for Office Use On Buildin Perff"umbat. Date Issued: Signature: r Certificate of Occupancy Building Otfiaal ate is is not required Section 1 - Site Information 1.1 Property Address 1.2 Zoning Information: OIL Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (r,I.O.L. c. 40. S 541 1.5 Flood Zone Infomration Comments: Public Private Zone: BFE Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Rae* : f d.UC r� O2321 N ( nt) Mailing Address: !1f-Z6�-?412 S nature Telephone Telephone 2.2 Authorized Agent: -Tw 1p_ R)p(an Q II I IA b�ri 1 - Telephone c Section 3 - Construction Services 3.1 Licensed Construction Supervisor. Address [INw1wol'u'p, u E ■u� C 1 I Not Applicable Jcense Number Expiration Date 1 of 4 OVER 3.2 Registered Home Improvement Contractor. Company Name Address Not Applicable 1-J Registration Number Expiration Data Signature Telephone 1 Section 4 - Workers' Compensation Insurance Affidavit (MAL l~ 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .... ... No .......... FSection 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of enclosed space) Section &l Registered Architect Not Applicable ❑ Name (Reglatranttl pegistration Number Address Signature Telephone Section 5.2 Registered Professional Engineers) Name Address Signature _ Telephone Name Address Signature Telephone F Expiration Date Registration Number Expiration Date Area of Responsibility Registration Number Expiration Date Area of Responsibility Registration Number Expiration Data Name Area of Address Telephone Section 5.3 General Contractor Company Name Person Responsible for Consmnl:lon Address Signature Telephone Number Expiration Date Not Applicable ❑ 2of4 Section 6 - Description of Pnnnnsed Work (check all annlicahlel New Construction ❑ (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ I Repair(s) ❑ I Aiterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Section 7 - Use Group and Construction Type Building Use Group (Check as appficapable) Construction Type A ASSEMBLY ❑ A-1 ❑ Al ❑ A-2 ❑ A-5 ❑ A-3 ❑ to ❑ 1 B ❑ B BUSINESS 2A ❑ 2S ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 3B ❑ I INSTITUTIONAL ❑ 1.1 ❑ 1-2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL. ❑ R-1 ❑ R-2 E] R-3 ❑ SA ❑ SB S STORAGE ❑ S-1 ❑ S-2 C] U UTILITY ❑ SPECIFY: SPECIFY: SPECIFY: M MIXED USE ❑ S SPECUILUSE ❑ Complete thissection if existing building undergoing renovations: additions and/or change In use. Existing Use Group: Existing Hazard Index 780 CMR 34 1 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Helqht and Area Budding Area Number of Moors or stories include basement levels Floor Area per Floor (sf) Total Area All Floors (s Total Heiaht (it) Section 9 - STRUCTURAL PEER REVIEW (780CMR 11011) Independent Structural Engineering Structural Peer Review Required Yes _........ No .......... SECTION 10a OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNER'S AradlTbR CONTRACTOR APPLIES FOR BUILDING PERMIT 2 , as Owner of the subject property, hereby authorize S J U QE' 14 IpLk& A my behalf, in all relative to work authorized by this building permit application. Signature of Ownap,� pD e to act on 3of 4 OVER SECTION 10bOWNER/ AUTHORIZED - r If 1, . %J KA as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to ' the best of my knowledge and belief. Signed under the pains and penalties of perjury. C J _ A -So\ Print Name f ///ell Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant t. Buildirg 2. Electrical 3. Plumbing / Gas 4. Mechardcal (HVAC) 5. Fire Protection EL Total a(1+2+3+4+5) 7. Total Square FL ib m sncum & a"ho* Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) - 4of 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigadons 600 Washington Street Boston.. MA 02111 • www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaolicant Information 1 /1 Please Print Legibly Name fBusiness/Omani7ntinrtnnrl;IA h,.tI•W /In,l.� /) Y —Y Oe-31 ✓N—,,-J 1 . o %,rt 10Lau tc,I : Phone M Are you an employer? Check the appropriate box: I M I am a employer with ( -4. (] I am a general contractor and I employees (full and/orpart-time).• have hired the sub -contactors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required:] ae 3. ❑ I ahomeowner doing all work myself. [No workers' comp. insurance required.]. _._ t 3a.0 I am a home ocn'ng as a general contractor (refer to #4) listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.: 5. We are a corporation and its officers have exercised their . right of exemption per MGL --- c.152, § 1(4), and we have no employees. [No workers' comp, insurance reOnlredl. �� K.� Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs ` - - ME] Other 'Any applicaat that cheeks box #1 mast also fill out the section below showing their workers' co mpematio3luoliry information t Homeowners who submit this affidavit indicating they are doing all work and then hue outside eonrraetors must submit a new affidavit indicating such. tContraaors thu check this box must attached an additional sheet showing the name of the gub_coubsctors and state whether or not those entities have employees. If the sub-mntractors have employees, they must provide their workers' comp. policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Policy # or Self -ins. � M (n - - Job Site Address � � City/State/Zip: � , � r �( Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiratlon date) 2% Failurd to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here lly ccttify under the pains and penalties of perjury that the information provided above it true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/LIcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information' and Instructions . Massachmem General Lawn chapter 152 requires all emPloy&s to Provide workers' compeaastioa for their Mvklyeee. Pursuant to this statute, an uRpfiltt is defined as "..-every person is the service of another under any contract of bite+ express at implied, oral of written." An sarp&yw is defined as "era individual. PatoetshiP, usocMM corporation or other lepl entity, ormtwoormolu or the of the foregoing engaged m a joist erderpcise. and incitdiag the legal represe�tiva of a deceased empioya, receitraescof as is Mdttal, patsasw usocudm a other legal entity, employing emPkY"' Howtrrer the ver a owner of a dwelling house having not more than three and who resides thaM or the Occupant the dwelling house of another who employa Pasoan to do ma' � construction a repair work on such dwelling house or as the grounds of building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter I52,123C(6) also states that "every state or local licensing agewy shall wfthiold the Iaausaa W renewal of a iktaas or permit to operate a budaas or to conaMnd ba0dtsp Is tlss eommoawealtk for nay applkaat who has not ---Awed acceptable evfdeees of eomes pNanwhir the bmwaaee ceverap requk jwum Additionally. MGL chapter 152+ PSM states "Neitha the commonwalth not say of its political subdivisions shall eater into =7 contact fat the puftmaaee of Public work until acceptable evidence of compliance with the hanaance mquiremeate of this chapter have bees presented to the contraetiag authontY." Applicants , Please fill out workers' the c=peaution affidavit completely, by checking the boxes that apply to your situation and, if necessary. supply sub-contractor(s) nam0(s). sddrets(es) and pbxw nomba(s) along with their cutifieate(s) of C (LLG7 at Limited Liability Partnerships (LLP) with no employees other thm the �' patngrted a w�orhria' compenasdoo imtaance. If as LLC our LLP does have members at partners, a+s not:egnutd eatel► employees4 a policy is reqaired. Be advised that this affidavit may be submitted to the Department of Industrial Ac;i The coa&mation of lasuance coverage. Alm be sure is sip and data the at &YIL The affidavit should be returned to the city or town that the apply zdm The the past or license is being requeste4 net the Department of Industrial Accidents. Should you have any quesdOOs regarding the law or if you ara reelau to obtains wakes' compenaation policy, please call the Department at thenumbet listed below. Self -inn sed companies should eutst their self iawaann Heenan number our the apptopsia*" him City or To" otz erau Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill oat in the event the ot8ce of Investigations has to contact you regarding the aPPlicat Pleurae be sure to fill is the permiUliceme number which will be used as a reference number. In addition, an applicant that mast submit multiple permit kcme spplic-&m in nay given year, need only submit one afgdavit indicating current po&y information (if necessary) and under "Yob site Addtesa" the applicant should write "all locations in (city or town)." A copy of the dMxvit that has beta officially stamped err marked by the city a tower maybe provided to the applicant a proof that a valid affidavit is an We far fiftm permits or licenses. A new stfidavit mess be filled out each year Where a home owner too cbuzn nis obtaining d ice= or permit not related ter is NO required m cornpkde iffidsnbusiness or cOMMCMW venture (Le. a dog Hceme or perrtatperson The Office of Invesdpdow would like to thank you in advance foe your coopendou and should you have any questions, please do not hesitate to give us a call. the Department's address, telephones and furs number: The Commonwealth of Massachusetts Depttttmeat of Industrial Accidents oMeg of Investiptlons 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-377-NIASSAFE Fax M 617-727-7749 Revised 11-22-06 www.mas,T.gov/di0 • ,o ' R,� o O •�i TOWN OF YARMOUTH BUILDING DEPARTMENT PLEASE PRIM: CONSTRUCTION SUPERVISOR FORM job Location: Number Owner of Property: Construction Supervisor - Address: Licensed Designee: (If other than Supervisor) Street Name License No. Village Name License No. 2.15 Responsibility of each license holder. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is, not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities tinder the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ No ❑ If you have checked = please indicate the type coverage by checking the appropriate box A liability Insurance policy .❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General taws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owners Owner ❑ Agent f] Signature: Building Official Approval: o� •YARD • �' C o TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address Is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. Date WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803 (800) 876-2765 NCCI NO 26158 ITEM 1. The Insured Mail Address: Bagels & Beyond LLC 311 Rt 28 Street No. POLICY NO. I VWC 6015935012012 PRIOR NO. I NEW BUSINESS West Yarmouth MA 02673 Town or City County State Zip Code FEIN xxxaN558 ❑Individual ❑Partnership ❑Corporation ❑Joint Venture ❑Assoclation ®Other Ltnited LIabUUy Co Other workplaces not shown above: 2. The policy period Is from 07/30/2012 to 07/302013 12:01 a.m. standard time at the insured's mailing address. 3. A Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Rom 3A The limits of our liability under Part Two are: Bodily Injury by Accident $ 100.000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating plans.. All information required below Is subject to verification and change by audit. Classifications Premium Basis Rates Cod. Ett"ad PW SIW Estinwlad Na Total Amual Of Annual Rannaatlon Wmrrradm prank= INTRA 1007493 SEE E ITENSION OF INFORMATIC N PAGE Minimum premium $ 216.00 Total Estimated Annual Premium $ 1.036.00 As indicated Interim adjustments of remium shall be made: Deposit Premium $ 1,068.00 ® Annually ❑ Semi Annually Ll Quarterly ❑ Monthly MA Assessment Chg. $762.85 x 42000% $32.00 . This policy, Including all endorsements, Is hereby countersigned by 07/302012 Auft rtmd Slptted ry Data GOV STATE GOV CLASS KIND AUDIT PLACING OFFICE CLAIM OFFICE NAME CHECK SAFETY GROUP MA 9079 2 6W WC 00 00 01 A (7-11) YttluGa copy *hw maww d to National C=x1 an Coeparation Yw nnim used with Is pami ak n Marshall K Lovelette Ins Agcy P O Box 836 West Yarmouth, MA 02673 M NOTICE TO EMPLOYEES NOTICE TO EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY VWC 6015935012012 07/30/2012 - 07/30/2013 POLICY NUMBER EFFECTIVE DATES P O Box 836 Marshall K Lovelette Ins Agcy West Yarmouth, MA 02673 (508) 775-4559 NAME OF INSURANCE AGENT ADDRESS PHONE Bagels & Beyond LLC 311 Rt 28 West Yarmouth, MA 02673 EMPLOYER ADDRESS 07/30/2012 EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named Insurer is required In cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services In accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the Injured employee. The employee may select his or her own physician. The r=uuable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF IiOSPITAL ADDRESS �r rn!ITTT T1X7 r, lAArWr "X7V1U TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398.2231 e41261 BUILDING PERMIT i llf 7=1: &V lip s �_l, Temp Permit No.: T-13-206 Applicant Name: Julie Moran Applicant Phone: Building Location: Owner's Name: 0311 ROUTE 28 CARVALHO, JASON, TR Owner's Addres 35 Boxwood Circle Bridgewater MA 02324 Owner's Telephone: (508) 269-7912 REVIEWED BY: (OFFICE USE ONLY Recorded By. Ic Permit Fee: $50.00 Deposit Rec: $50.00 Payment Type: Check ChkNo.: 302 Net Owed: $0.00 Application Date: 11/30/2012 Issue Date: Expiration Date Comments: Map/Lot: 030.26 USE & OCCUPANCY -BAGEL SHOP -OWNER CHANGE ONLY - OCCUPANCY SUBJECT TO ALL FINAL INSPECTIONS 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: WA: 4. HEALTH DEPARTMENT: DATE: N/A: 5. BUILDING DEPARTMENT: DATE: N/A: 6. FIRE DEPARTMENT: DATE: N/A: COMMENTS: RECEIPT OF COPY: PLEASE NOTE SIGNATURE OF APPLICANT: DATE: Date Printed: 12/5/2012 �t,�,� TOWN OF YARMOUTH s` c HEALTH DEPARTMENT o~ t ��'•%" PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: "Ifyou would like e-mail nolifrcalion ofsign off; please provide e-mail address:, Owner Name:�n toI COMM, ''�-f /� ��?y Owner Addres � LOUPC I\C 1 -a 111M�'""`6wner Tel. No.p I -'70bi —/Lt5 RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note. Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: 0 ' - DATE: I I_)z-1 z PLEASE NOTE H S.&ea .DYla,IL !a tSS with 1`u.d pernll rie-elS7a -e,&3,-j4e-,0 YARMOUTH FIRE & RESCUE Commercial Building Permit Sign Off Project Name:Bagels and Beyond Contact Name: Julie Moran Address: 311 Rt. 28 W. Yarmouth Phone #561-706-1145 Y NO NA Subject Regulation E S ❑ 1 ❑ Access for Fire Apparatus 527 CMR 25.02 Building Numbers MGL Chapter 148 sec 59 *Flammable gasgiquid storage 527 CMR 14.03 Fire Lanes 527 CMR 10.03(10) "Service Stations 527 CMR 5 & 9 *Hazardous Materials Storage 527 CMR 25.08 *Kitchen Exhaust Systems 780 CMR, 527 CMR 10.03(8) Extinguishers 527 CMR 10.02, Chapter 148 sec 28 *Fire Alarm Systens/CO detection 780 CMR, Chapter 148, 527 CMR 24,CMR 31 *LPGStorage Chapter 148 sec 9,10,28 & 527 CMR 6 Pesticide Storage 527 CMR 37 *Sprinkler Systens 780 CMR & Chapter 148 sec 26 A -I Storage inside/outside Buildings 527 CMR 10.03(5) *Upholstery 527 CMR 29 *Trash Containers 527 CMR 10.04 & 34 Any Hazard to the Public Chapter 148 sec 28 *Curtains, Draperies, BUnds 527 CMR 21 Description of planned project/other requirements: No construction, new owner. MGL AND FIRE TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. ERRORS OR OMMISSIONS 00 NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF OAS BUILT' COMPLIANCE. DATE: t- v'l)- INSPEtTOR YFD permit required -depending on occupancy and submittal Plan Reviewed By: Captain Sawyer�ieaa /za r S, V" Date: 11/30/12 Copy for Applicant® Copy to Building Dept.® Copy to Fire Prevention , !��519-�.. _ .�-i � - - �i I i 1 ! I -�� I_�1 ��,�i_f�-�-1 I_I ► (_i_ I f_ _I_f- - - (_�st-_ -- - - - _ _-_.�-_I- I + � ( I I I I I I f—C_I �C1_f_1_ - - - I -(- - i- � - ------1- _- _ -II--_ II------ ----1I---1_�___------- -__1_ J_��-- E--d �(I I___�——�— —( --_ 1 a-_ i-I E I FI F i I ! . � 1! I I f-1 . ► 1, I 1 ► + _b_ -�_col,ct � �' I - --_-- _ _ - -( i= �► -� �1 �13��i�i -i i 1 I � � I �i^ xa�-�.t- i I � ! (i � __l._ �� _ - - -f -(- - _- - 109- -i-- ! - - - j-� -►--5 r� I-i- (► I I ! i � � I I �I I i (-(-i ! I � �.,j--� 4 �, 1 �'r' Co�r4 � ( � � -_ � _ t�f`"I�i� 1 , � � � , , , l�� 1 r1✓ � � i � i � I��c• � � ' � � - _ �I - - i - i-�1 Imo+ i-(_ L_ i ► I = f - _! I ► , I- _�1_ I_�.! _ —i—F — — f —I ^_ IT — �f _FFF -F,- FV �, f _ - - -�,If -If -- �� "�1,,s,I .! o ' R TOWN OF YARMOUTH o BUILDING DEPARTMENT o� y 1146 Route 28, South Yarmouth, MA 02664 ` MAR ,. o 4.1 508-398.2231 ext.1261 Fax 508-398.0836 JUL 2012 ZONING DETERMINATION FOR BUSINESS CERTIFICATE APPLICATION The purpose of this form is to determine whether your business complies with the Town of Yarmouth Zoning Bylaw. The applicant shall complete the top section of this form and file it with the Building Department. Once the Building Department has made a determination, it will be forwarded to the Town Clerk. The Building Department will render a determination based on the following factors: (a) The business/rue, activity, (b) The zoning dirtrict in which the business is to be located Allowed urea are based on Zoning Bylaw Table 202.5 and (e) Previous or new zoning reliejfrom the Zonisj Board ojAppeals The applicant acknowledges that a determination will be made by the Building Department based on the Information provided on this date and any changes in the business use and/or activity will require additional approval. Failure to do so may result in the revocation of the Business Certificate and/or appropriate Zoning Enforcement, should It be determined that the changes are non -compliant. 9S for Disapproval t':Jv 1 DEPARTMENT DETERMINATION (office use only) Zoz.-r R �faxrachuxcttx - D j ward of Building R �nmcnt of Conslatinnz •Public Safct� tructfon Supervisor and Standard.% License: CS Sg�1 License BRlqN p CAVE B HERITAGE CR0.SSIN(3 MIDDLEBORO. MA 02349 F t'orm„1..a„�r Expiration: aS2012 O Trk 3323 1 5 _ =�\ Olree of Con aumerdsine � Regalatioe !F HOME IMPROVEMENT CONTRACTOR Registration: sy20918 Type: \ Expiration:W20,i2012 Individual BRA CAVE ^� BRIAN CAVE 6 HERITAGE CROSSING-' MIDDLEBORO, Undersecretary Date: 1/11/2011 Time: 3:57 PH To: 15083982262 Horae Insurance Page: 02 ACC>RDr CERTIFICATE D/11/DDIY OF LIABILITY INSURANCE 1 111/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement s . PRoaxErt NAME: Laura Wiesner Morse Insurance Agency,Inc. 285 Washington Street PHONE (508)238-0056 see>23o 836T WC, No, E,Q: WC. No): ADDARESS.laurawiesner@morseins.com North Easton Village Shoppes PRGDucERIp D0013141 North Easton MA 02356 INSURE S AFFORDING COVERAGE NAIC0 INSURED INSURERA NGM InBAranCel Company 4i88 INsuRERs Associated Employers Ins. Cave Corp. 6 Heritage Crossing INSURERC: INSURERD: INSURERE: Middleboro MA 02346 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. LNTR SR TYPE OF INSURANCE ADM S POLICY NUABER POLICY F MM! MMI X LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMSMADE I X IOCCUR 09486J 0/1/2010 0/1/2011 EACH OCCURRENCE r 1,000,000 PREMISESS 300,000 MED EXP (Any one person) PERSONAL S ADV INJURY { 5,000 S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC PRODUCTS -COMPIOP AGG $ 2,000,000 t AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIREDAAUTOS SCHEDULEDAUTOS IRUTOS NON-OVWEDAUTOS COMBINED SINGLE LIMIT (Ea accident) S BODILY NJURY (Per person) BODILY NJURY (Per sa:ldent) $ $ PROPERTY DAMAGE (Par scader() $ S S UMBRELLA L Aa EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DEDUCTIBLE RETENTION $ S S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTPEREIECUTIVE OFFICERR& BER EXCLUDED? [E] (Mandatory In NH) II yea, describe hider DESCRIPTION OF OPERATIONS be4ow NIA 00761.201.2010 0/1/2030 0/1/2011 X WC STATU- OTH- ER E L. EACH ACCIDENT $ 500,000 EL. DISEASE -EA EMPLOYEE r 500.000 EL DIEEACE-POLICY LMIT 0 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is raqulnd) Project: 311 Route 28 Yarmouth MA (508)398-0836 Town of Yarmouth 1146 Route 28 South Yarmouth, MA 02664 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Wiesner/LMW ACORD 25 (2009/09) INS025 (200909) The ACORD name and logo are registered ID CORPORATION. All rights reserved, 9 b.L� U V i5 II TOWN OF YARMOUTH AUG 12 2010 U BUILDING DEPARTMENT 6 Route 28, South Yarmouth, NIA 02664 SO�3 rio 0'2�5� BUILDINGDEPT 08-398-2231 ext.1261 Fax 508-398-0836 WW' 1 BY %�%� ZONING DETERMINATION FOR BUSINESS CERTIFICATE APPLICATI60rVe The purpose of this form Is to determine whether your business compiles with the Town of Yarmouth Zoning Bylaw. The applicant shall complete the top section of this form and file It with the Budding Department. Once the Budding Department has made a determination, it will be forwarded to the Town Clerk. The Budding Department will render a determination based on the following factors: (a) The busineu/use, activity, (b) The zoning district in which the business is to be located Allowed uses are based on Zoning Bylaw Tabk 202.5 and (c) Previous or now zoning reliojfrom A* Zoning Board of Appoah The applicant acknowledges that a determination will be ma4e by the Building Department based on the information provided on this date and any changes in the business use and/or activity Will require additional approval. Failure to do so may result in the revocation of the Business Certificate and/or appropriate Zoning Enforcement, should it be determined that the changes are non -compliant. Applicant's Signature Date BUILDING DEPARTMENT DETERMINATION (office use only) Approved / � V /Y 1_t� Disapproved Reason for Disapproval Building Official's of r TOWN OF YARMOUTH Building Department BUILDING5 ('08) 398-2231 ext.261 PERMIT NO B-04-1467_ ........... PERMIT ATM ISSUE DATE ; _ 6130/2004 _ ; PROPOSED USE APPLICANT ,JasonCanvelho .P JOB WEATHER CARD ......................... . PERMIT TO Use and Occupancy, AT (LOCATION) 100311ROUTE28 ZONING DISTRIC B2 Bldg.Type: Commercial SUBDIVISION MAP LOT BLOCK LOT SIZE BUILDING IS TO BE: CONST TYPE 5•B I USE GROUP USE & OCCUPANCY: BAGEL SHOP - OCCUPANCY SUBJECT TO ALL FINAL INSPECTIONS. REMARKS SEATING CAPICITY: 18 AREA (SO FT) EST COST ($ $0.00 PERMIT FEE ($) OWNER IJason Canvalho BUILDING DEPT BY ADDRESS 100311 ROUTE 28 West Yarmouth MA 102673 CONTRACTOR LICENSE 0 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector s w TOWN OF YARMOUTH r Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 BUILDING PERMIT B APPLICATION RECEIPT Temp Permit No.: T-03-510 Applicant Name: Jason Canvalho Location: 00311 ROUTE 28 Owner's Name: Jason Canvalho Owner's Addres 00311 ROUTE 28 West Yarmout MA 02673 Owner's Telephone: (508) 269-7912 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $35.00 Deposit Rec: $35.00 Payment Type: Check ChkNo.: 2012 Net Owed: $0.00 Application Date: 5!7/03 Issue Date: Expiration Date Comments: USE & OCCUPANCY: BAGEL SHOP - OCCUPANCY SUBJECT TO ALL FINAL INSPECTIONS. SEATING CAPICITY:18 ZOPJING APPROVED This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 5/8/03 A 0 OF YIA A� �.ATTACM&E r BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT,'REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of larnlouth Building Deparunent 1146 Rome 28 • Yarmouth, NIA 02664-•4492 FAX: Ted: (508) 398 2231 x2fi1 •Fax: (508) 398-23fi5 Only Planning Board Information Assessors Department Information Office Use Permit No.A�Kate Permit Fee $ IA V 7 — , , �(, Deposit Rec d. $.�� at�-� Net Due $ Plan Type Endorsement Date Recording Date _. . Plan No. Other Map Lot .lip t Old New 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only BuildingPermit Number: Date Issued: Signature: S' ) , U Certificate of Occupancy Is is not required B ' ing Official Date Section 1 - Site Inf mation 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use r� 1.3 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Reco Na rint 79 Z. Si ure Telephone Mailing Address: Telephone 2.2 Authorized Agent: Name (print) Signature Mailing Address: Telephone I j Y Section 3 - Construction Se 'ces 3.1 end Construction uper ' or: Not Applicable ❑ License Number Address Expiration Date �� Si Telepho 9-15-99 1 of 4 OVER 3.2 Registered Home Improvement" Contractor: Company Name Not Applicable ❑ Address Registration Number Expiration D Signature Telephone Section 4 - Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted ith this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Not Applicable ❑ Name (Registrant): i Registration Number Address i i Signature Telephone Expiration Date -- ---- Section 5.2 Registered Professional Engineer((s} Name Area of Responsibility Address Signature Telephone-------- Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Section 5.3 General Contractor Not Applicable ❑ Company Name Person Responsible for Construction Address Signature Telephone 9-15-99 2 of 4 U Section 6 - Description of Proposed Work (check all applicable) New Construction ❑ (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: O ,�- �i.. ; Section 7 - Use Group and Construction Typbl Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ A-4 ❑ A-5 ❑ to ❑ 113 ❑ B BUSINESS 2A ❑ 2B ❑ 2C ❑ E EDUCATIONAL F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 36 ❑ I INSTITUTIONAL ❑ 1.1 ❑ 1.2 ❑ 1-3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 513 S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: SPECIFY: S SPECIAL USE ❑ Complete this section if existing building undergoing renovations, additions and/or change in use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (if applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor (sf) Total Area All Floors (St) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent structural Engineering Structural Peer Review Required Yes .......... No .......... SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTJa#CTOR APPLI S FOR BUILDING PERMIT 1 C(l0� , as Owner of the subject property, hereby authorize to act on .044f-'c2 my behalf, in all mattersrelativeto work authorized by this building permit application. Signature of Owner�s Date 9. 15-99 3 of 4 OVER 10b OWNER/AUTHORIZED AG 1 it T hereby dec that the statements an informal the best of my k wledge and belief Signed under the pa and penal 'es of perjury. DECLARATION • as Owner uthorized A e on on the forgoing application are true and acurate, to Si<jrtature of Ownent / Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant t. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) ___— -- 5. Fire Protection----- — -- — - 6. Total = It + 2 + 3 + 4 + 5) 7. Total Square Ft. (for new strucnnes & edditlons) Check Below ❑-Conservation-Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) 9-15-99 4 of 4 .YAR'i 3 c TOWN ,OF, YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location: Number Owner of Property: Construction Supervisor: L Name Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License Village License No. Phone No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official ir, writing of the discovery of any violations which are covered by the building permit. 2.15.4 Anylicenseewho shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked M, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General laws, and that my signature on this permit application waives this requirement. Check one: Signature of owner or Owner's Agent Owner Q Agent El Signature: Building Official Approval: The Commonwealth of Massachusetts Department of Industrial Accidents 01Aceello�esl/pstliis 600 Washington Street. Boston, Mass. 02111 Workers' Compensation Insurance Affidavit u k— G u'7 O 1 am a homeowner performing all work myself. O 1 am a sole proprietor have no one working in any capacity an employer pro%iding workers' compensation for my employees working on this job. company amee address! Vl,,rJ Sfi city. ---U 14, nt V GI- % 3 phone N: �� ` / �i� %0 •)C � 0 lam a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have• the following workers' :ompcnsation polices: company name• address* city: phone q• insurance co. policy N Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Impooldon of erholaal peasides of a flat op to S1.S00.00 and/or one.years' Imprisonment as well as civil penalties In. the form of a STOP WORK ORDER and a Ilse of Sltlll.00 a day &pint me. I &&demand that s copy of this statement maybe forwarded to the Ogee or investigation of the DIA for coverage verificadoa. t do hereby eertij�r the Print name of perjury that the injormadan provided above it true and eom///55�� Date > �-7 3 official use only do not write in this sres to be completed by city or town official city or town: YARMOUTIJ p check if Immediate response is required K permit/license 0 r'+Buildiog Department ❑Uceasing Board 261 OSelectmen's Offer cnb% & QHealth Department contact person: phone #. _ % J7&.W 31 est. nOther Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers.to provide workers' compensation for their entplo%ees. As quoted from the -law-, an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written.. Art.enrph�rer is defined as an individual, partnership, association. corporation'or other legal entity, or any two or more of the foregoing engaged in a joint enterprise. and including the legal representatives -of a deceased employer, or the receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance. construction or repair work on such dwelling house or on the grounds or building: appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL chapter I section 25 also states that even• state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any vho has not produced acceptable evidence of compliance with the insurance coverage required. applicant t Additionall%. neither the commonwealth_ nor any of its political subdivisions shall enter into any contract for the — performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter has, e been presented to the -contracting authority. Please fill in the workers' compensation affidavit completely. by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. The affidavits may be returned to the Department by mail.or FAX unless other arrangements have been made.. The Office oflnvestigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents flfffee of IltresllHatll is 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749- phone 9: (617) 7274900 eft. 406, 409 or 375 if TOWN OF YARMOUTH 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS026644451 Telephone (508) 398.2231, Ext. 261 — Fax (508) 398.2365 BUILDING DEPARTMENT DEMOLITION• DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work demolition to be conducted at T- ZK Work Address," is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. gnatur pplicant Permit No. :�D Da / pp�e�al Expires on: 12/05/02 us QUOTE WORKSHEET Wip Number: 194594 Version Number: 110 Insurer GRANITE STATE INSURANCE COMPANY Underwriter C I FELL I , JEAN Branch ASSIGNED RISK Broker MARSHALL K LOVELETTE INSURANCE AGENCY Insured JASON CARVALHO Effective Date 12/05/02 Expiration Date 12/05/03 Anniversary Rate Date „ Rating Plan RISK ID: ".! i •' "' COVERAGE A: YES EMPLOYERS LIABILITY: 100,000/ 100;000/'7 500;000 CAUTION: This quotation Is an estimate based on the representations of the named Insured, and Is subject to all policy terra and conditions, rates and underwriting rules In effect during the coverage period, In conformity to applicable laws. LWO997 (Ed. 9-91) INSUREDS COPY :u 0 S oc`- .VtU` 11 a� ti V/ _41 of „-91 5� a-J? 12 'ci c »i2 --m-30 I alb OL szc�m i3tlOu`�,� 1.1 04 •YAR`�a O H 03,51D �r Building Site Location: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET No: -Lot No: ZQ1 Address: Te1No.s SO d 9 Date Filed: 5 OF �� The BuildingDepartment will be responsible for assisting the applicant b dispatching Dep po g pp y patching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT. Determines Compliance to State and Town Requirements for Personal ..................................................................................................................................................... Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT: DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: /• Wbikcopy -BufldmgDML - PWk copy -wata DepL - Yd1owCapy-HWthDTL - fidUpy-E*w=4DvL - G.Wd-Fi¢DcpuConsunfi. s�oIe L/ 11 .._. Building Site Location: R_kf o3,51a TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET No: -aL_Lot No: U .s 7�� The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. �� 1l._.. MM1IQZKIMlut&T-6i iLMKIIJ1*0iz[r1 WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Ads; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations% Le., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: _--A-DATE: N/A �1! 4. HEALTH S. WUUNG INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: WbacDpy-$u5dmsDax - Pink copy-W&WDcpL - YdIawCopy - DepL - Piok Copy -En&=ingDcpL - Go1dand-FuoDepL Caxwvafw ��7 J el IG'�LCI. JV R a a v :5AfKauim p 46 ' v !� 33 lY N OC GO 72 _ m� pA - f-., - -- - - . . .- -.-- - - - .-., - .*- w /,03.5la Building Site Location: 0_k .3 ., TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SIIEET No a _Lot No: ' 1 ,6 S The Building Department will be responsible �� ' ding Departm pon5ible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; Le., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; Le., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. .................... REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT DATE: N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRINGINSPECrOR: DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A 7,,, jIRE.DEPARTMENT:— j — - . ------ —DATE: 5 ) o3 N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT. DATE: -ir Whirc copy - Dw1dwg DcPL - Pmk spy - Wua Dept. - YeLow Cd;y -H=A I!bcpL -,Zpk Copy-Eov=4 Dcpt- `Ga dmW -'�Dgl,11 oscvatiao 5AfKawn S ace t,Lc! I r � �► � . �' .40 y►�40Z ''�� --- Z11 S�/� SO? oL ►h7 c� c 0 umce use uniy i DPermit #.. l — a , u JAN 11 011 Fees Permit expires 6 months from 4 issue date. EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: Sy/ Lff%4/rl D 60, / ASSESSOR'S INFORMATION: Map: (J Parcel: OWNER:s/Lf0// L4-'log. NAME CONTRACTOR: NAME PRESENT MAILING ADDRESS 3 vat Sod ;Z&9 791 TEL # 623 S/ MI�7,10E(3o� mit- lvy—d-c-�B-77&—; TEL # Residential Commercial 0 Est. Cost of Construction $ 3 Yey d (�_ Ilome Improvement Contractor Lie. # 1430716 Construction Supervisor Lie. # l 5 7 1 Workman's Compensation Insurance: (check one) I am the homeowner I am the sole proprietor �kesompensation Insurance Insurance Company Name: Worker's Comp. Policy# WORK TO BE PF.RFORbtED 0 Tent (Fire Retardant Certificate attached) 0 Wood Stove Shed 0 Sidiag: # of Squares �eplacen»t windows: # ❑ Replacement doors: # 0 Electrical I'eimit # 0 Re -roof. # of Squares 0 Insulation ( ) Stripping old shingles• 'The debris will be disposed of at: ( ) going over layers of existing roof Facility ❑ Old Kings Highway/Historic District Roormg/Siding (Like for like) I declare under penalties of perjury that the statements herein contained are we and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of my license and for prosecution under M.G.L Ch. 268, Section 1. Applicant's Signature: Date: 0 Owners Signature (or attachment)- 1 r Approved Building designee) Zoning Itistorical District: Yes p4o Water Resource Protection District: Yes I)(p Date: Flood Plain Zone: Yei Within 100 ft. of Wetlands: Yks No 3/01 } The Commonwealth of Massachusetts Department of Industrial Accidents Ogee of Investigations 600 Washington Street Boston, MA 02111 �=p' www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Leeibly Name (Business/Orgmizadon/Individual): ✓c _e01 Address: A D , t3o-�- --uityiatatetzip: K 7Laa , /x✓6/ /v� Phone #• 3-V Areyouan employer? Check the appropriate box: E, 1. 1 am a employer with % 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required:] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required] t 3a. ❑ I am a homeowner acting as a general contractor (refer to #4) listed on the attached sheet. These sub -contractors have . employees and have workers' comp. insumnce.t 5. ❑ We are a corporation and its officers have exercised their . right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reauired.l —a-o e— 770 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other , fAny applicant that checks box #1 must also fill out the section below showing their workers' eompemadod bolicy information. Homeowners who submit this affidavit indicatin; they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcmttactors tad state whether or not those entities have employees. If the sub-cootnctors have employees, they must provide their workers' comp. policy number. lam an employer that is providing workers' compensadon insurance for my employees. Below is the policy and fob site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: ?l / M4 / h City/StatelZip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above Is hue and correct Phone cP 77J lz QQ?eid use only. Do not write In this area, to be completed by city or town 0i ieiai City or Town: PermittLicense # Issuing Authority (circle one): L Board of Health 2. Building Department 3. Cityfrown Clerk 4. Electrical inspector S. Plumbing inspector 6.Other Contact Person: Phone #: Information and Instructions Massachusetts General Lawa chapter 152 mquira all employers to Provide workere' compeaation rot their employees. an avpl pusmu t to this statute. �'i is defined as "...ever person in the service of another under soy coottact olhira. express of implied, oral or written. An tasplgar is defined as "an individuIX P aaaoch&% corporation or other legal entity. of my two cc mote of the foregoing engaged In a Joist adapci w, and inchtdttig the legal ieP of a deeeased empbya, or the receiver or trustee of so tadMdml. parwashilk assoeiadon Of other legal endye employing UVk* We. How" the owner of a dwelling boase having not mace than three spectmemts and who resides tlraW k err the of the dwelling house of another who employe persons to do msintenaoce, construction or repsit wrack on such dwelling horse or on the pounds or building s shall not bccaus@ of rich employment be deemed to be b@ an empto MOL chapter 1529 I25C(6) also states that "every stab er i@eal Itee=Wg agesey shall withhou the isn W" K renewal d a liesn" or parmk to operate ■ business or te cam' eI bedidlaga to the eeooeeatwaalth fur say appiksat Who has net predsesd acceptable avideate of eompmases with the lasersaa eoversge radish a AddidoodlY. MOL chapter 132.123C(7) states "Neither th@ commonwealth nor any of its Political subdivisions shall enter into say contract for the pafbtmaom of public work until acceptable evidence otcomPlfanea with the insurance requirements of this chapter haw been presented to the contracting authority." Mon APPliesaa Please IM out the wmim , compensation anidavit completely, by checking the boxes that apply to your situation an4 if necessary, supply (g) neme(s). addres (es) and pb xw number(s) aloof with their cadficate(s) of innnu . Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with on anpbyees other then the members at twbwM are not M*md to carry wo fee' compensation huuaaaee. It an LLC or LdP does have maybe suinnitted to the Department Of Industrial Accidents s, a Poo b �° Be'advised !let � be race to sip and date the dWavfL The affidavit should Aeebdeatt for coafirmatlos at inaaane@ covaap. of be:Weaned to the city a tows that the sppU0WOs for the Pamir err!ferns@ IN being mquatod. s@t the industrial Acciderm. S6oaldyou haw gay quesdone reprdhrg tha law or if you sm requited to obtain s wakese9 comoenadoo policy. please call the Department st the number listed below. Self-insuWd companies should enter their City @v Tows Ot>!elsis Plesse be we that the affidavit is complete and printed legibly. Th@ Department has provided a spec@ at the bottom of the affidavit for you to fill out is the event the offie@ of Investigations hoe to contact you regarding the aPplkaat Pleas@ be we to All In the persafiNeeme number which will be used u a reference number. in addition. an applicant that and submit multiple pamdNllcenes applications in any Sim yeart need only submit one affidavit indicating ceaWnt PC b dbcmadoa (if necessary) and under "lob Slit Address" the applicant should writs "all locations 14 (city of rked by the city or town may be 10 the town)." A copy of the affidavit that has been officially staa>ped or licenses. A new affidavit oast lot tilled out each applicant as proof that a valid M&vk is an Me for fi m permits or Yew. Where a home owner or citizen is obtaining a !keno or parsft not misted to any business or commercial vendee (i.e. a dog Ueensa or penidt to burn leaves etc.) said pasts is NOT required to complets this aQidevit The Otfia of investigations would Iron to thank you is advance for yeas cooperation and should you have any quesdor@6 please do not hesitate to give us a all. rM Department's address. telephone and fax nunim The Commonwealth of Massachusetts Department of Industrial Accidents Of&* of Investfpdotaa 600 Washington street Boston, MA 02111 Tel. A 617-7214900 ext 406 or 1-977-MASSAFE Fax N 617-727-7749 Revised 11-124)6 mminass.gov/dia TOWN OF YARMOUTH Building Department BUILDING __ (508) 398-2231 ext.261 SPV1092R)PERMIT NO 8-03-%27 ''PERMIT ISSUE DATE ;. _ _ .... _ . _ ; PROPOSED USE ' APPLICANT JasonCanvalho JOB WEATHER CARD ADDRESS '327 Route 28 PERMIT TO Alterations AT (LOCATION) 100311ROUTE28 ZONING DISTRICT JB2 SUBDIVISION MAP LOT BLOCK 1030.26 1 BUILDING IS TO BE LOT SIZE I I CONST TYPE Interior alterations: remove two non -bearing we] & rt ring wall, create opening to 1EMARKS outdoor freezers, add bracing in attic s ns ubmitted 2/21/03. AREA (SO FT) EST COST ($ $3,500.00 PERMIT FEE OWNER Jason Canvalho ADDRESS 1327 Route 28 BUILDING DEPT BY INSPECTION RECORD USE GROUP CONTR'S LICENSE 080884 CONTR'S NAME Lee, Chris FIELD COPY Date Note Progress - Corrections and Remarks In ector ✓1 . �/ 0-6t; - ' 3-�3 -F - 1)4 _� l 410 M BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH Aly1T$UILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Yarmouth Building Department 1146 Route 28 • Yarmouth, NIA 02664-4492 Tel: (508) 398-2231 x261 • Fax: (508) 398-2365 FAX _ L use On ,, I Planning Board Information Assessors Department Information: J^ g _SMI/1 Plan Map Lot M!30 Al t r� —emu Endorsement Date O/d New �Jl ecording Date 1�at�} a Pik 1.4 Property Dimensions: r Other Lot Area s (q Frontage (ft) Lot Coveraaa This Section for Office Use Only BUY T Pe i urnber• Date Issued: 9 tore Si na Bulling Officia Date —�3 Certificate of Occupancy Is Is not required Section t•Sitelnformation 1.1 p� pehY Address 1.2 Zoning Information: Zoning District Proposed Use t •g gvildinl Setbacks (ft) Front Yard Required Provided Side Yards Requir d ProvidedlComrments: Rear EYard 1.4Provided Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Zone:I�FE_•— Section 2 - Property Ownership/Autho iz A en l� � 2.1 Owner of Record: Ire Name (P ) Signature Telephone R 0 4112003 Ti I in Address: G T n Telephone 2.2 Authorized Agent: Na riot) ture Section 3 - Construction Services 21 2003M i i ress, Q ��7 3.1 ns r r„ ri j f s ru��rvisor: _Q � Not Applicable ❑ \� License Number z�PD 6 �� Addres 577 Expiration D to �✓ 2� Sig ature Telephone Im 9- 15-99 1 of 4 OVER 3.2 Registered Home Company Name Address Contractor: Not Applicable ❑ �i Registration Number Expiration Dale Signature Telephone Section 4 Workers Compensation Insurance Affidavit (M G L c 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for. Buildings and Structures Subject to Construction' Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of'enclosed space) Section 5.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number LAddress Signature Section 5.2 Name Address Signature ff Name Address Signature Name Address Professional Section 5.3 General Contractor Company Name Person Responsible for Construction Address Telephone Telephone Expiration Date Registration Number Expiration Date - Area of Responsionir Registration Number Expiration Dale Area of Responsibility Registration Number Expiration Date Not Applicable ❑ A#r" 1 9-15-99 2 of 4 r section 6 - Description of Proposed Work (check all applicable) New Construction ❑ I (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. Repairs) 9PAlterations ep I Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief escription of Pased Work: j P ll e�z� Section 7 - Use Group and ConstructioplAe Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ A-4 ❑ A-5 ❑ 1A ❑ 1113 ❑ B BUSINESS 2A ❑ 2B ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 3B ❑ I INSTITUTIONAL ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑/ 5B I� S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: SPECIFY: S SPECIAL USE ❑ Complete this section if existing building undergoing renovations, additions and/or change in use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (if applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor (sf) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 117) Independent Structural Engineering Structural Peer Review Required Yes .......... No .......... SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR ONTRACTO APPLIES FOR BUILDING PERMIT as Owner of the subject property, hereby authorize C�l r<� ��`P to act on my behalf, in all matters relative to work authorized by this building permit application. iregnatuo ner Date 9- 15-99 3of4 OVER SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION � ro. iti r •. I, j(!i- o as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains a'N penalties of perjury. MIN Print Name Signature Owner/Agent Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant 1, Building r. 2. Electrical ov 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total -(t+2+3+4+5) 7. Total Square Ft. (ta new structures a aditms) Check Below ❑ Conservation -Commission Filing (if applicable) _ ❑ Old Kings Highway & Historical ---Commission approval (ifapplicable) M Date 9-15-99 4 of 4 TOWN OF YARMOUTH BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASEPRIIVT Job Location: Owner of Pro] Construction Supervisor. Address: Name Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. 0�� License No. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction,- alteration, repair, removal or demolition involving the structural elements of building and structures onlypursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ❑ NoK-- If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 o Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature QfD%Vner or Owner UU Agent Q Signature: Building Official Ant)roval: .A The Commonwealth of Massachusetts Department of Industrial Accidents OIAceoI/JYestlOMINs 600 Washington Street Boston, Mass. 02111 _4_c='� Workers' Compensation Insurance Affidavit A Ilkantinformation: PieafcPRi1VT ++-& city _- phone e 0 f am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in am' capacity 0 lam an employer pro%iding•workers' compensation for my employees working on this job. insurance co. policy 0 lama sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have the followin_ workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL I52 can lead to the impositions of crimlaal penalties of a One up to S1,40all and/or one years' Imprisonment as well as civil penaldes in the form of a STOP WORK ORDER and a Bag of $100.00 a day against me. I aadentsad tint a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. t do -hereby certify under the pains and penalties of perjury that the information provided above is true and carrel Signature Date Print name Phoned official use only do not write in ibis area to be completed by city or town official city or town: YARMOUTIJ _ permit/license N Z3Buildlng Department pl.lcensiog Board check if immediate response is required 261 OSeleetmea's Offer OHealtb Department eontace person: phone N; _ (508) 398 -2231 eat. nOther ................ • a AT Information and . Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "law• an employee is defined as every person in the service of another under any - contract of hire, express or implied, oral or written. An e►nph�rer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives -of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein. or the'occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplover. NIGL'chapter 152 section 25 als-. states that every state or local licensing agency shall withhold the issuance or renewal of a license or pernift to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The af7idavit should be returned to the.city_or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. The af0davits may be returned to the Department by. -mail or FAX unless other arrangements have been made. The Office of'lnvesti'gations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents MCC of lftvestillulls 600 Washington Street Boston, Ma. 02111 fax 9: (617) 727-7749• phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF YARMOUTH .1146ROUTE28 SOUTH YARMOUTH MASSACHUSETTS02664-4451 Telephone (508) 398-2231. Ext. 261 — Fax (508) 398-2365 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT BUILDING ELECTRICAL, GAS PLUMBING SIGNS Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from th/ee roposed wor /demolition to be conducted at 3 �� 2 T' -De e is to be disposed of at the following location: Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. 1 ature of Applicant Permit No. . 2011 - /W Date V al Co. 5Afgwxvl � ?C TiLJC��LCL' a� yc�-- TWO 72 3 trc "`, 1 Fl,rz rk� jr/4-rron �Nti�yfs . �Asia. COUN %'CrG�� z y f/ >/NUJ oaf �►3Y�W tt -.0 )V7t IVIA0 -.-?ZVJ0 / 03/12i2004 12:38 5085835477 PAGE 01 TO: FROM: RE: BAGELS Fs BEYOND 311 Main Street W. Yarmouth, MA 02673 508-790-8500 Freshly Baked Bagels Made From Scratch Everydayll FAX TRANSMISSION JIM BRANDOLINI JASON CARVALHO PARKING LOT 03/12/2004 12:38 5085835477 March 12, 2004 Jim-. Hello Juts, I am faxing you the plot plan for 311 Main Street along with the approximate changes that I am requesting. The changes are as follows: 1. Erect retaining wall, approximately 6 feet tall and the length of the property 2. Backfill to build up grade 3. Top area off with crushed stone 4. Upgrade existing septic system to H2O using mbar and a 6 inch platform The reason for the retaining wall is that the landscape behind the building severely slopes downward therefore making a retaining wall necessary. Since my southerly border contains wetlands I will have to meet with Brad from Conservation to get the accurate 'buffer' between the wall and the wetlands. I talked to Bruce in the Health Department and he approved of the upgrade to H2O using the rebar and reinforcing platform. As you know, the reason for my request to make my property 'self sufficient' in the instance that the Yarmouth House separates our adjoining parking lots. This separation would eliminate the use of the curb cut that is located on their property but used in day- to-day operation of my business. Please note that I have not yet talked to an engineer. I wanted to check with you before I moved this project further. All the schematics that I have presented are approximate and obviously can changes slightly when an engineer is brought into the picture, I look forward to hear from you, please give me a call and we can plan a meeting or further go over the particulars. 0 Jason Carvalho n �� Bagels & Beyond �`/ ,✓/`�J 508-790-8500 ✓✓✓ / PAGE 02 m A'A�L o. • m ®r . / ✓ 17L.Z/EeF/ ss11LT. MAP ,fit EA ' i aas s oet —_� rY it AL �- - - - _ • � � v /STORY 1 , FRAe IF LdT 3 C�wcD X eLp6 ` ,` 2q jaa rf f � 5� �ar�'.St Crt,.�•S+tc' i M h _ •Tl O� —Ed;" ZA [/yF �i LI � O 03 fi L m N Ln } o � co V j eor'0. N /I So N401. 1 �- m + m Oe �f � 1 Nr m a IL rl Nr c*m W IPl m U') m c*m N .4 V m m N N •-1 cn m aLK &---?- -� t� DIVE i::_ OF Y, TOWN OF YARMOUTH AT: UN 2 2 2004 U E�riT�D BUILDING DEPT. Sc — APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By� C Fee: $ 2Sy PERMIT NO. Date 1-7:5 260q Owner's Name Rblei Ad) &Vod() type o ccupancy New❑ Renovation El Replacement �Y Submitted Yes ❑ No ❑ fn Y cc W y W W UO Z cc 2 fn Cr Cn X W O 0 m Z (n 0: Q CC w w O Q = w Q W0 a W FW- Q= Z Q W n= Q W z rW- W a F z��} N maQ z o W o y s Q= O FE LL 7 o V ¢ > cc 0. O 0= C9 J G FW- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) T n� Check One: Installing Company Name J. V�+. 7 �A�1S (��,,,a�v�n�IlTfart7❑ Corp. _ Address l L( JJ ► ru, ct1, A/�a/�_ se!)a Noyl-k 5 mA , o?Lroo Business Telephone Lbl 2, k�----n \ 2 Name of Licensed Plumber or Gasfitter ❑ Partnership — irMCompany INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes 1* No ❑ If you have checked yes, please indicate >4ype of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I haw (or entered) In above application are true and accurate to my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 2&1V5- License Number TYPE LICENSE: � Plumber ❑ Gasfitter ❑ Master DIourneyman TOWN OF YARMOUTH r 0 7 2003 L cloy � �Y s APPLICATION FOR PERMIT TO DO PLUMBING i (OFFICE USE ONLY) By A(__ Fee: $ 71 V. S d PERMIT NO. P r D3 D Date OwnerToiQpn C4ryQ I hn Building 's AT: Location 311 M1611hS Name esk rw1a h mpr 0A73 Comm rcicc Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No z ? N Co p y Y > 6, Y J N U Q t- Z (7 N M S (n z y w H w ¢= CD M U.O Z z z a O o a ¢ CCwO�¢ w Cn WZ pjZOC LL Fw- V> F O S O (n F- Z O O rA Z Z W N ILL O V w 3 Y g m 0 o o g 3 °x N LL 0 D o a 3¢ m o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name Mik, Grew Address `I-S AV11110 Ln Check One: ❑ Corp. _ ❑ Partnership Ctnt(ryil)c, mpr ab3;L [� Firm/Company Business Telephone sob- �20- *0 3a Name of Licensed Plum/ber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes IM No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature ofOwnerorOwner's Agent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ Signature of Licensed Plumber ao3y6 License Number Type: Master Journeyman :C TOWN -OF YARMOU ...� 0 7 2003 t% AT: Location I w New ❑ //Plans Submitted mq ih Renovation/ Yes❑ No[] APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY �L Fee: $ ( SO PERMIT NO. t_i^ 03 Owner's -y^ ' l- Name BIASO1) Cgwl ho nati�� Typ of ccup cy CDYAbley-&41 Replacement El rN Y cc ¢ UO z CC S cc Ul zI- J w z z a S a� W a z 2 a O� O w W m r w z °° > W W Q y W W Z Q a= F>- cc w M m W W W xN 0 t- Cc W z '� a� Q 1= a 0 z O Z w x o w a m W> a W M z 3 cc a 5 o o o o x 0 x U. D a o 0 m> o. F- SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Ch�°e&5 : Installing Company Name Mike Gyw Address HS hhiiLo 1 OfHu ',IIe mA MID- 0 Corp. ❑ Partnership WFirm/Company Business Telephone 509- -Igo - agYc)- Name of Licensed Plumber or Gasfitter M) ke Crew INSURANCE COVERAGE: Check One I have a current liability Insurance policy or its substantial equivalent. Yes % No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability Insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Signature of Licensed Plumber or Gasfitter License Number TYPE LICENSE: Plumber XGasfitter ❑ Master Journeyman f _. , APPLICATION FOR PERMIT TO DO PLUMBING TOWN OF YARMOUTH (OFFICE USE ONLY) By — Fee: $ S3 I ii ) io3 31 (/ PERMIT NO. t;ppt 0 2. 2003 -'/ � �`,� date y � 20 _ Building � Owner's L345CU AHo 13e{ as Al: Location Name Type of Occupancy f'o,nlmer-x;st New ❑ Renovation 0K Replacement ❑ Plans Submitted Yes ❑ No ❑ z z N Y J N Q O U z a N W M W cc N z N -1 Cn W D: _ �' z � O z O z y z o OJ uJ W uJ FQ, N=¢ F- a w rn y Y ¢ a LL a d a c) z¢ ¢ N W r N z o Q y z¢ a. X of U. x 3 S Oa z_ N 3 Y a. 0 ~ i Z a w LL Y w FW- Cxi a J m N QQ a O Q O O N Q M Q W 2 P a O 0 U Q x F- Y O G J 3 2 F- rA LL 0 0 0 Q cc m O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR + 3RD FLOOR -+I++ (PRINT OR TYPE) Check One: Installing Company Name TNzal(15 Ql�mB12S�-H�A7lA' ❑ Corp. Address 14 A i rl t m a 20 , ❑ Partnership O pPvr A �S hgr 0?(elC2n Firm/Company Business Telephone Svc —325S =23 12 Name of Licensed Plumber Aim e S wt TAZA14 5 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes Ir No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ©"�— Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent I hereby certify that all of the details and Information I have submitted (or entered) in above application are true and accurate to the bes my knowledge and that all plumbing work and installations perfQ� under Permit Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Check on Owner ❑ Agent ❑ of "—' "IG)0S' License Number Type: Master 11 Journeyman B' t TOWN OF YARMOUTH (70�oi Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 ext.261 P Building Location: 00311 ROUTE 28 Owner's Name: Jason Calvalho/Bagels & Beyong Owner's Address: 00311 ROUTE 28 West Yarmouth MA 02673 Owner's Telephone: Plumber Name: License Number: Company Name: Company Phone Pazakis, James 26105 J.M. Pazakis Plb (508)737-6563 PERMIT TO DO PLUMBING WORK (OFFICE USE ONLY Recorded By: Ic PERMIT NO. P-03-521 Permit Fee: $53.00 Payment Type: Check Check Number: 1031 Issue Date: 4/2/03 Type of Work: Renovation Comments: kitchen sink, 2 lays, laundry trays, water piping INSPECTION RECORD Date Note Progress - Corrections and Remarks Inspector `//Y�`�' SINK /il S/i✓`ii OV CN 7.VJ'� ' s �c� �C-, 2 a � � • rn, Es �- c kc� Loom as S (4-4( wD t 5 T Pb73- t 5 GPM '� Qml 4-TC51 Vs ow C, 04 ✓um, F} GCC—C7S o (gt U (A r` c6s r. or V fcro tS octscs OU6V C.-A Tegz ( K E u Flisj Lij ve 4,t i� ate( l t r Data Printed: 417103 OFFICE MEETING NOTES ADDRESS: 3 �2 DATE: /f- -21 Names of Attendees: 114�lr«/ Zoning District: v /� � -.2- G Flood Zone: C- Meeting Topic: ierQ ' J,�rzA 11'�7 V of TOWN OF YARMOUTH Building Department BUILDING : (50 99 2231 .261 '- PERMIT NO - 6-03-1134• PERMIT 1T ISSUE DATE ; • • •6/6/03• . • ePF POSEDCAME APPLICANT JasonCalvalho JOB WEATHER CARD ADDRESS 00311 ROUTE 28 PERMIT TO Alterations-------------- ; AT (LOCATION) 100311ROUTE28 ZONING DISTRICT JB2 SUBDIVISION MAP LOT BLOC 1030.26 BUILDING IS TO BE USE GROUP LOT SIZE I CONST TYPE CONTR'S 081815 reinstall winodw on side of building & install screen door per request of BOH. REMARK AREA (SQ FT) EST COST ($ $275.00 PERMIT FEE OWNE Jason Calvalho ADDRESS 100311 ROUTE 28 BUILDING DEPT BY LICENSE CONTR'S NAM Hanbury, David INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks inspector 45�; `l BUILDING PERMIT APPLICATION 1 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. 3 Town of Yarniouth Building Department 1146 Route 28 • Iarniouth, NIA 02664-4492 Tcl: (508) 398-2231 x261 • Fax: (508) 398-2365 FAX: Office Use Only Permit No. �h G Permit Fee $•!S�o !!�� Deposit Rec'd. $ 77"Uate Net Due $ a Planning Board Information Aqn Type Endorsement Date Recording Date Plan No. other Assessors Department Information: Map tot tot Old New 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: Signature: 3 Building Official I Date Certificate of Occupancy is is not required Section 1 - S e Information 1.1 Property Address: Sla MA,iJ S ll 1.2 Zoning Information: 3 ;- Zoning District Proposed Use IJ • ✓, DW1�7 1.3 Building Setbacks (it) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) is Private 1.5 Flood Zone Information: Comments: Zone: C BFE: Section 2 - Property Ownership/Authorized Agent 2.1 Ow or of ReU tl �r Nam rint) Mailing Address: Si ature Telepv'a J elephone S 2.2 Authorized Agent: Name n ing Addre : Signature Telephone. S0.21 p az4T Section 3 - Construction Services 3.1 LIcepsed..Constryction Syrp�� l . Not Applicable ❑ �/• - ��it�3r�[.cJ �, License /N+um er Address Expiration Date e S 6 6 /8/.S� ' Signatur T phone sad o z 9-15-99 1 of 4 OVER 3.2 Registered Home Improvement Contractor: Company Name Not Applicable ❑ Address Registration Number Expiration Date Signature Telephone Section 4 -Workers' Compensation Insurance Affidavit (M.G.L. c. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Signature Telephone Expiration Date Section 5.2 Registered Professional Engineers) Name Area of Responsibility Address Signature— -Telephone -- — — Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Section 5.3 General Contractor Not Applicable ❑ Company Name Person Responsible for Construction Address Signature Telephone 9-15.99 2of4 Section 6 - Description of Proposed Work (check all applicable) New Construction ❑ 1 (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: I Me Brief Description clProposed Work: n , — `� Wui,yxl�wV*J Section 7 - Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ A-4 ❑ A-5 ❑ 1A ❑ 1 B ❑ B BUSINESS ❑ 2A ❑ 2B ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGHHAZARD ❑ 3A ❑ 313 ❑ I INSTITUTIONAL ❑ 1.1 ❑ 1.2 ❑ 1-3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 513 ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: SPECIFY: SPECIFY: M MIXED USE ❑ S SPECIAL USE ❑ Complete this section if existing building undergoing renovations, additions and/or change in use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (if applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor (sf) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes .......... No .......... SECTION 10a OWNER AUTHORIZATION - TO BE COMPLETED WHEN, OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 11u . -' , as Owner of the subject property, hereby authorize � to act on my behalf, i matters relative to work authorized by this building permit application. Signatureev,Owner Date 9-15-99 3of4 OVER AUTHORIZED AGENT DECLARATION 1, J+� , as Owner/Authorized Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signat of Owner/Agent Section 11 = ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =It +2+3+4+5) 7. Total Square Ft. pa new shr"es 6 additm) Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) Date 1 9.15-99 4of4 7 TOWN OF 'BUILDING C0N'STRU.CTION. PLEASE PRIAT. Job Location• YARMOUTH DEPARTMENT SUPERVISOR. FORM 07.• bd /G9,emacr'�� 4M 0&7-Z Number Street; / Village Owner of Property�d Construction Supervisor-9ri3'� �`� �6 Name n 'License No. Phone No. Address: �`� / ry�%'%� " . u •.�%�� d� /N� C'�67_ Licensed Designee: (If other than Supervisor) Name License No. 2.15 Responsibility of each. license.•holder:, 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done. pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder: shall, be- responsible.to' supervise the construction, reconstruction, alteration, repair, removal or demolition invoMng the structural elements of building and structures only pursuant to the state building code and"all•otherapplicable-laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfully violate subsections 2.15.1, 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who . is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license :holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the' err' it conditions: I have read and understand'my.responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109a;1,:of.the state building code. I understand the construction inspection procedures and,tlie specific in pection as called for by the building official. INSURANCE COVERAGE: have a current ability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes (� No ❑ If you have checked y_U, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee dgg not have the insurance coverage required by Chapter the Mass. Ggneral Laws, and that my signature on this permit application waives this requirement. i _ f _ ", > Check one: Signature of Owner or Owner's Owner ❑ Agent � Signature: Building Official Approval: The Commonwealth ofMassaehusetts Department of Industrial Accidents Office 011"OslJpsdies 600 Washington Street . . Boston, Mass. 02111 Workers' Compensation Insurance Affidavit nime, �/�i/�%//O]'' //i'/ATV •y�(tt�./��r� location-, �7 ��/`�"'�2�^7 � rt r citL W '`� •<tt3�u�� '(� Da-ey7-3 phone# O 1 am a homeowner performing all work myself. 0'1 am a sole proprietor _ad have no one working in an • capacity O 1 am an employer pro,. iding•workers' compensation for my employees working on this job. romttan--me: Linr�� ►2a/ city:�Y,'lf , [Q-17�� phone a• Q✓`C7� o2 ZZ insurinceco,7i�ii �e/i�n+//C4�o�. Policy a �C�SQ�%Q p 290 I am a sole proprietor. general contractor, or homeowner (circle one) and have hired the contractors listed below who have the followin; workers' compensation polices: Failure to secure coverage as required under Section 25A of MGL IS2 can lead to the imposition of critalsul peaaltla of a nae op to 3I.S00 00 and/or one years' Imprisonment as well as civil pensides to the form of a STOP WORK ORDER and a nee of SI00.00 a day against me. 1 anderstead that a copy of thisstatement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do -hereby Cq*)Yu3deJ1 thepains and nal es of perjury that the information provided above Is true and correct Signatu au Print name j (/f t� ` ,d Phone lf 6? ' O r Official use only do not write in this area to be completed by miry or lows official city or town: YARMOUTII _ permitAicense a nBuilding Department ❑Licensing Board p check if immediate response is required 261. QSelectmen's Office Health De artment contact person: phone a; _ (508) 398--2231 eat. nothcr p Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under anv contract of hire, express or implied, oral or written. An empl(trer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the'occupant of the dw elling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIG1_ chapter 152 section 2 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for am applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting, authority. Applicants Please fill in the workers' compensation affidavit completely. -by checking the box that applies to your situation and --supplying company names, address and phone numbers as all affidavits may, be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the pennit/license number which will be used as a reference number. The affidavits may be returned to the Department by. -mail or FAX unless other arrangements have been made. The Office of 'Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents MCI If levostlNSUIRS 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 exL 406, 409 or 375 TOWN OF Y A R M O U T H BUILDING ELEGrRICAL 1146ROUTE28 SOUTHYARMOUTH MASSACHUSETTS02664.4451 GAS Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS .BUILDING DEPARTMENT DEMOLITION- DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at �� %11 A) 37 ,)If `-1.q/0�,yt rT// Work Address is to be disposed of at the following location: n6,a)tK �"� l M7PS7c�2 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature ofApp icant Permit No. Date 04/11/2003 07:11 5085835477 PAGE 01 TO: FROM: RE: BAGELS F�BEYOND 327 Main Street W. Yarmouth, MA 02673 508-790-8500 Freshly Baked Bagels Made From Scratch Everyday!! FAX TRANSMISSION r.—od -R�, dmpw, "o 'esTiwts 2-zQ s t 12Z ?ems Tncwat�-I 6 OUJdL 04/11/2003 07:11 5085835477 PAGE 12 Hpr 08 03 02:16p James M. Pazakis 5083852712 P.2 16- Z JMP=ahQ'Iumbin1;(a)atrhi. corn April9, 2003 Dear Potential Customer. Prttperry located Al: 311 Main St. W. Yarmouth. Ma. 1 hereby propose to: Remove existing Hater closer and law in exlsling bathroom and replace with two (1) hathrooncs .side by side !n the same Incanon as existing both with two (2) water closets and two (2) lays, using owners existing lay In one bathroom. This proposal is hared on the as rumplion that the designated bathroom area will he the same as is existing, and the only changes are that the layout is changing to accommodate a seconxl bathroom creatingseparate men s and women's employee facilhiec`Also pleaus note that all demolition required to access piping, including. but i not limited to. loorin�, removal of concrete, replacement of concrete, walls, cel ings. dooms, framing, electrical,'and atry other special _ iitttatiotrs that may arse Ne the responsibi!try of the property owtter.� Me use of lype L Wrought copper (in till potable water supply connections The use Ylype M Wrought copper un all healing supply aril return piping %he use of all requiredsafety devices as required by Mass Code 248 C.M.R. The above equipment .'project will he lastalled far the price of S---3396.00 !s drnvn with dinned contract in the amount equaling S--1698.00 Pi Doe upon c mnplelims ofJob in the amount 1qualing „5-11198- 00 The Above equipment /o be lnuial/ed at the proprrty located at 3/1 Main St. West Yormoulh, Ma. PP- < ". of TOWN OF YARMOUTHA-Building Department BUILDING - - - - " • - (508) 398-2231 ext.261 PERMIT NO " ....:-82' _ PERMIT 38" 82 ISSUE DATE :- ..413103• - - : PROPOSED USE APPLICANT �Jason caivelho - - • - - • - - - - - - - - • ' "' JOB WEATHER CARD ADDRESS :00311 ROUTE 28 PERMIT TO : MiscJmechanical -- ... ... .... .... ..------------ AT (LOCATION) 100311ROUTE28 ZONING DISTRICT JB2 SUBDIVISION MAP LOT BLOC 030.26 BUILDING IS TO BE USE GROUP LOT SIZE CONST TYPE CONTR'S LICENSE 0 Install exhaust hood CONTR'S NAM REMARK (P) Fraatz, Rudy AREA (SO FT) EST COST ($ $1,800.00 PERMIT FEE ($) 1$50.00 OWNE Jason Calvalho ADDRESS 100311 ROUTE 28 BUILDING DEPT BY INSPECTION RECORD FIELD COPY Date I Note Progress - Correctlons and Remarks I Inspector I L� �� MECHANICAL PERMIT tDATE R CONTRACTORS LICENSE NO. P9RMIT NUMBE BLDG. PERMIT NO. LOCATION i��,�,��5 + �''t(1A11) 311 Mnln( JL OWNER Cr4Z-Vg1—N6 KIND OF BUILDING USED ASl— TO BE COMPLETED ABOUT ESTIMATED COST $ S9 ()O NEW—CALTERATIO )— REPAIR — ADDITION (Circle One) —Of ❑ GAS ❑ LPG ❑ ELECT. ❑ TYPE OF EQUIPMENT NUMBER FEE Air Cond. Units—H.P. Ea. Refrigeration Units-H.P. Ea. • Boilers—H.P. Ea. _. Forced Air Svstems—B.T.U. MEa. Grevlty Systems—B.T.U. MEa. O_ Floor Furnaces—B.T.U. M IL ,. Wall Heaters—B.T.U. -- M 41 . Unit Heaters—B.T.U. M W LL e Conversion Burner LL 'C fothes Dryer Os = Ventilation Fan O �Itenos Hood \ / Q F � endling C.F.M. G J Incinerator Gas Piping wt Range COM. DOM. W lY N W K F TOTAL FEE CONTRACTOR'S NAME AND ADDRESS CITY ZIP CODE READY FOR INSPECTION ON OR WILL CONTACT PERMIT CLERK LATER V (date) APPLICANT CERTIFIES THAT ALL INFORMATION GIVEN IS CORRECT AND THAT ALL PERTINENT MECHANICAL ORDINANCES WILL BE COMPLIED WITH IN PERFORMING THE WORK FOR WHICH THIS PERMIT IS ISSUED. �J % J 7 Signature of/Contractor or hs Authorized Signature of of Permit Representative Making Application ✓/ INSPECTOR'S COPY COPYRIGHT U 1973 BUILDING OFFICIALS a CODE ADMINISTRATORS INTERNATIONAL. INC. OU INSPECTORS COPY ON REAR INSPECTION REPORT DATE PURPOSE INSPECTOR REMARKS: 4- BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of Yarmouth Building Department 1146 Route 28 - Yarmouth, 111A 02664-4492 Tel: (508) 398-2231 x261 - Fax: (508) 398-2365 FAX Office Use Only Permit No - Permit Fee $ Deposit Rec'd. $Date 3 � � Net Due $ Planning Board Information Plan Type Endorsement Date ecording Date Plan No. Other Assessors Department Information: Map Lot Map o Old New \ 1.4 Property Dimensions: Lot Area(si) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number: Date Issued: Signature: Certificate of Occupancy Is is not required Building Official Date Section 1 - Site Information 1.1 Property Address: n ►^�AitV Si Q' 1.2 Zoning Information: Zoning Districl Proposed Use 1.3 Building Setbacks fit) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply (M.G.L. c. 40. S 54) Public Private 1.5 Flood Zone Information: Comments: Zone: BFE: Section 2 - Property Ownership/Authorized Agent 2.1 O ner of Rec d: ��fi�cd �11 m#7W fr t) Mailing Address: aEr7 0—�520M0! Sig ature - Telephone Telephone 2.2 Authorized Agent: TH A CII f lL M F" t 4 Name (print) Mailing Address: -PVDV 'RAA`rz- oft-dR - 4S5 Signature Telephone Section 3 - Construction Services 3.1 Licensed Construction Supervisoir 2 �1,1 Not Applicable ❑ MAR 2 003 o' License Number Address ' Y Expiration Date Signature Telephone 1of4 OVER 3.2 Registered Home Improvement Contractor: < Company Name Not Applicable ❑ r Address Registration Number Expiration Date Signature Telephone Section 4 Workers' Compensation Insurance Affidavit (M.G.L. c.152 S 25C ( )) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes .......... No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c.f. of enclosed space) V, It Section 5.1 Registered Architect: NotAppilcable ❑ Name (Registrant): Registration Number Address Signature Telephone Expiration Date Section 5.2 Registered Professional Engineer(s) Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registratlon Number Signature Telephone Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Section 5.3 General Contractor Not Applicable ❑ Company Name Person Responsible for Construction Address Signature Telephone 9- 15.99 2 of 4 N ection 6 - Description of Proposed Work (check all applicable) New Construction ❑ (for multiple family only) No. of Bedrooms (for multiple family only) No. of Bathrooms Existing Bldg. ❑ Repalr(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: Section 7 - Use Group and Construction Type Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A•1 ❑ A-2 ❑ A-3 ❑ A-4 ❑ A-5 ❑ 1A ❑ 1 B ❑ B BUSINESS ❑ 2A ❑ 2B ❑ 2C ❑ E EDUCATIONAL ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ H HIGH HAZARD ❑ 3A ❑ 30 ❑ I INSTITUTIONAL ❑ I.1 ❑ 1-2 ❑ 1.3 ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ 5B ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: M MIXED USE ❑ SPECIFY: S SPECIALUSE ❑ SPECIFY: Complete this section if existing building undergoing renovations, additions and/or change in use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (if applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor(sl) Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes .......... No .......... SECTION 10a OWNER AUTHORIZATION • TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I TIJW&AJ C Fr1vywo as Owner of the subject property, hereby authorize `7'jqn Clq f h f�m/ to act on my behalf, in all matters relative to work authorized by this building permit application. t3 40/U3 Signature o ner Date 9-15-99 3of 4 OVER AUTHORIZED AGENT DECLARATION P 1, , as Owner/Authorized Agent hereby declare that the statements and Information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing / Gas 4. Mechanical (HVAC) 5. Fire Protection 6.Total =(1 +2+3+4+5) 7. Total Square Ft. panew srucMm 6 eddi inns) --------—Check Below ❑ Conservation -Commission Filing (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) Date 9-15-99 4 of 4 • ''��Y"R� TOWN OF YARMOUTH O � y •�? BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRIM. Job Location: Number Street Village Owner of Property: 7:� A rn 4 5 AA lR f!I joy Construction Supervisor. Name. License No. Phone No. Address: Licensed Designee: (If other than Supervisor) ivame 2.15 Responsibility of each license holder. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising, He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction,- alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1, 2.15.2 or 2.15.3 or any other section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes ta No ❑ If you have checked yo, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Signature: Owner ❑ Agent Q Building Official ADDroval: The Commonwealth ofMassachusetls Department of Industrial Accidents office ofloYest MOSS 600 Washington Street Boston, Mass 02111 Workers' Compensation Insurance Affidavit Applicant information: PieasesPRINTTEes'hiu eity phone M 1 am a homeowner performing all work myself. CJ I am a sole proprietor --d have no one working in any capacity V 1 am an employer pro% iding.workers' compensation for my employees working on this job. LQEu anx name: `-rN fa CN Fit M �sJ"7i f' t f}� address, + `f�a nal FfL LAIu � city: LA) A&rrfaAM VIA- phoneq: Sn9-a9S^59S5' insurance co. PV-MAiSSA/JC-C- CPov_P - __ ___ oolirv# 0002-16-? O 1 am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the following workers' :ompensation polices: Failure to secure coverage as required under Section 25A of MGL 152 an lead to the Imposition of edmiaal penalties of a pat ap to S1,MA0 and/or one years' Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fiat of S100.00 a day against me. I nadentaad that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage veriOatloa. t do -hereby certify under the point and penalties of perjury that the information provided above is tact and correct iignaturc - Date .3-AI-e3 Print name UOt f �'QR�1 2 Phone N SO o7 ? S ' J (lSS official use only do not write in this area to be completed by city or Iowa official city or town: YARMODTIJ _ permitAicense 0 nBuildiog Department ❑Ucensiog Board p check ifimmcdiate response is required 261 pSeltctmea's OMce (508) 398-2231 mot, 011ealth Department contact person: phoneM;_ _ n()ther Information and . Instructions Massachusetts General Laws chapter I52 section 25 requires all emplovers to provide workers' compensation for their enrplo%ees. As quoted from the** law-, an employee is defined as every person in the service of another under an% contract of hire. express or implied, oral or written. An enrpft trer is defined as an individual. partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives -of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the'occupant of the d" el line house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. NIGL'cliapter 152 section '5 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants -Please-fill in the workers`com—pen satiot aaffidnit completely, ey checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The afldavits may be returned to the Department by. -mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office tl Invesillaulls 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 TOWN OF Y A R M O U T H E�LI I, 1146ROUTE28 SOUTH YARMOUTH MASSACHUS=S02664-4451 GAS Telephone (508) 398-2231, Ext. 261 — Fax (508) 398-2365 PLUMBING SIGNS BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and'780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address is to be disposed of at the following location: AC41y iv LAN4 - WNL,04" 14 j1 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Applicant Permit No. 3 -ai v3 Date Hoo D rH w:.A il-f 14 A M tl rk. sot - .,2 95-5.q5V FlnE I YAnIIJO Mn_ I-llKj Pfj2Vl&lS 'LIC .07); VL300 i 77� -4 y�^�' — — -- -- -- 1- I - - I i Nor, D I Ns1-ra�A'11PAI,Jill t4av- : ! l60,0 wf�DCD �W:AiIWAM N 5o_ a9p•• !—_--- . • •- I— �---i— -_l _ - --- - I I � - I- - I I � -I - i j - nuc; Sot,-S-S.�iSS' - - � � I I � I � � � I I ' 'Ru�y rt�A>aT•z - _SL�ST"?M 'lie ISIs_�XN��sT _ I —I — — f I ��-1—�_I1l�oob Co_NS Lrrt>> N y/►NNrs tin ( l! N sL-6- ?3 T- I MiKfIPfnK1A15 _uc1091: 1500 •--�; i CFI'i . i iJ RILS�u7 o�c I 40a o I_r?nNc_�_c��na�?-'- _ G1ttoN. F%Ri Sup - }!- � I i t I .SySi`ff�l IusTYa(�TiD `r`o i _ I I �.IFIP,a'�7A ti uc300 ! fN5t1�g71oN 1I_ I t i p ACIfNIAA A)cd I i t -•. Ii l t' i l I I ! �• I I t— —1- --'— --' ! ! I I--'j '-I � 1 1 i 1 i �I ! i t 1 i� i , -, .1. � i � i •. _ . 0TOWN OF YARMOUTH Building Department Town Hall 0A Yarmouth, MA 02664 (508) 398-2231 ext.261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-03-407 Applicant Name: Rudy Fraatz Location: 00311 ROUTE 28 Owner's Name: Jason Calvalho Owner's Addres 00311 ROUTE 28 West Yarmout MA 02673 Owner's Telephone: (OFFICE USE ONLY Recorded By: Ic Permit Fee: $50.00 Deposit Rec: $50.00 Payment Type: Cash ChkNo.: 0 Net Owed: $0.00 Application Date: 3/21/03 Issue Date: Expiration Date Comments: 3o „Zb install exhaust hood 3 v This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 3/29/03 MECHANICAL P RMIT ' ter., DATE 3 a i) 3 PERMIT NUMBER - W 29 CONTRACTORS LICENSE NO. BLDG. PERMIT N0. LOCATION *10<15 4- FPfl,p ll LlI Sri OWNER _f4 �cs N eNL i/A!_ No KIND OF BUILDING iA)non USED AS �s�.�T�vannr TO BE COMPLETED ABOUT ESTIMATED COST $ 00 NEW - ALTERATION - REPAIR - ADDITION (Circle One) ❑ GAS ❑ LPG ❑ ELECT. ❑ TYPE OF EQUIPMENT NUMBER FEE �Air Cond. Units—H.P.-Ea. Refrlaeration Units—H.P. Ea. - - Boller—H.P. Ea. ... Forced Al; Systems-B.T.U. MEa. - Gravity Systems—B.T.U. MEa. ( �_ • Flow Furnaces—B.T.U. M < a „Wall Heater—B.T.U. M W • 0-Unit Heaters—B.T.U.M W U. . Conversion Burner U. 'Crothes Dryer O= Ventilation Fan O area Hood ~ andlinp C.F.M. O J Incinerator < Gas Piping N Renee COM. DOM. IY W K N < W K h TOTAL FEE CONTRACTOR'S CITY ZIP CODE READY FOR INSPECTION ON OR WILL CONTACT PERMIT CLERK LATER I� (date) APPLICANT CERTIFIES THAT ALL INFORMATION GIVEN IS CORRECT AND THAT ALL PERTINENT MECHANICAL ORDINANCES WILL BE COMPLIED WITH IN PERFORMING THE WORK FOR WHICH THIS PERM IS ISSUED. '3 W', '#'C; Q� 31 / Signature ofXontractor w hrs Authorized $}0nature of Permit Clerk Representative Making Application (/ FILE COPY S COPYRIGHT © 1973 BUILDING OF(ICIALS a CODE ADMINISTRATORS INTERNATIONAL. INC. _ 248 CII-IR: BOARD OF STATE EXAMINERS OF PLUMBERS AND GAS FITTERS 2.10: continued 6. All secondary and post secondary schools that conduct sporting or physical activities on school premises and/or have a gymnasium in which said activities may be conducted, shall have separate showers for each sex to accommodate students. All schools which have trade type programs in which student may become soiled, shall comply with 248 CMR 2.10(19)(h)6. 7. Deluge showers shall be installed in every school chemistry laboratory classroom, or any room used for similar purposes wherein flammable liquids and open flame devices are used in conformance with the most recant 527 CMR adopted by the Board of Fire Prevention. (7 Employee Facilities (Non -Industrial). 1. In each establishment where people are employed, there shall be separate rest rooms for.each'sex, located in each establishment and sbe plainly so'designated.' 2: Facilities in establishments referred tomhall 248 CMR 2.10(19) )1: within two branch levels shall be acceptable. Facilities shall not be required for mezzanines.. See 248 CNR 2.03: Me27anine. 3. Unisex toilet rooms are allowed if they meet the requirements of 248 CMR 2.10(19Xm). In business or commercial.estabGshments (except industrial) which contain less than, 1 "00 gross square feet of floor area or does not have.;easonable access (within 300, feet Viand on the same floor) to core or common facilities, one toilet room located within the r estabGshunent with the number of fixtures accordng to the standard set forth in 248 CMR t . t2.10(19)Table 1 for employee facilitie; shall mea the minimum requirement' » 5. In every establishment where only one person is employed or works,+there shall be one water closet and one lavatory for use of its tenant, provided within reasonable distance, not to exceed 300 feet Core or common facilities within reasonable distance (defined in 248 CMR 2.10(19)(1)4.). located on the same floor as the establishment being serviced and having separate designated facilities for each sex, may be used to meet the _ requirements of 248 CMR 2.10(19)(1)5. The number of fixtures in the core or common facilities shall be according to 248 CMR 2.10(19): Table 1 for employee facilities (non- industrial). 6. Where core facilities are allowed and in compliance with the code, additional designated toilet rooms shall be allowed within the establishment. These fixtures shall not be credited to the requirements of 248 CMR 2.10(19): Table 1. (j) Employee Facilities (Industrial) 1. In every industrial establishment, all toilei room facilities including the number and type of plumbing fixtures, the floors, walls, windows, ceilings, lighting, ventilation, doors, partitions, design and location of toilet rooms shall comply with 454 CMR 2.00: Toilets in Industrial Establishments. 2. Separate toilet rooms shall be provided for each sex and shall be plainly so designated. See 248 CMR 2.03: Menan;n 3. The number of water closets and lavatories shall be provided within reasonable access (defined in 248 CMR 2.10(19)V.) and in accordance with 248 CMR 2.10(19)Table I for industrial facilities. t 4. Reasonable distance for industrial establishments shall comply with the following: in no case may a water closet be located more than 300 feet distance from the regular place of work of the persons for whose use it was designed, except where service elevators, accessible to the employees, are provided 5. Each 20 inches of usable or circumference 18 inches sink will be considered as an equivalent of one lavatory. 6. In special industries of departments when there is undue exposure to poisonous substances or liquids or where the work is especially dirty, one lavatory or sink may be required for every five persons and in all cases, a potable water supply of hot and cold water shall be provided (k) Medical and Health rare S tild;ng Facilities, 1. In all medical and health are buildings there shall be separate designated toilet facilities on each floor for male and female patients and visitors. 2. The facilities may be located in a common or core area on each floor that is within - 300 feet of all offices. 3. Accessibility shall be direct; it shall not require going from one medical office through another. • 8/9/96 248 CMR - 72 04/11/2003 07:11 5085835477 PAGE 02 April 10, 2003 Kenn Bates clo Yarmouth Building Department: I am enclosing the estimates and costs pertaining to 311 Main Street. I am also enclosing the estimate for the second bathroom as well. The bulk of all necessary materials have been purchased and the only items needed would be mere incidentals. Your are welcome to take a tour of the project so you can see for yourself. The breakdown is as follows: Receipts Of Materials Purchased Hood System Required By Chief Raskio Plumbing For Sinks Etc. Total Project Cost Estimate For Second Bathroom (assuming That this was done from the beginning of Project) $29806.29 % $2,200.00 � L . 76. o $7,182.29 3 96.0 J Total Project Plus Estimate $109578.29 %` / 2 Cif As you can see that this does fall under the cap of $12,000. 3. 3. — I also took your advice and attained a copy of the assessmcrat of the property, which my lender performed, last February. Unfortunately the valuation combines both land and building, but based on the percentages that the town uses we can figure out the building value. Town Information: Total Value 164,000 100% Building Value 409000 (24%) Land Value 124,400 (76%) 30% of40,000 = $12,000 Appraisal As Of February 18, 2003 Total Value 290,000 100% Building Value 699600 (240/6) Land Value 2209400 (76%) 04/11/2003 07:11 5085835477 30% of 69,600= $20,890 We are not only under the value for the Town figures but we arc extremely under value for the updated figures of just two months ago. I hope this take care of the concerns of the second employee bathroom, I apologize for the inconvenience of this issue but, as you are aware, we were not privy to any bathroom' issues when this project was taken on. Please call me directly if you have any questions or further concerns and thanks for your time. Jason Carvalho Bagels &, Beyond 508-790-8500 PAGE 03 04/11/2003 07:11 5085835477 --� APR-09-2003 WED 10,22 fM CONFASS BANK ,^r PAGE 04 FAX NO. EBB 984 6894 P. 02 LOAN 'VAZrUATION SUMMARY Subject Property Addren o� legal Deseriptioa Ill I� 01A. Condor/akat )PAS Applicant's Kama --T. Impro►emenls to be eemplatcd Twpbo n Cesuw Tract Appra>sal to bo made of property in "Aa L" don (4 or "As Completad ( ) Location ( )Urbaa•• Bunt lip ()Owe �S'/• b93nbarban ( �d Grotrdr 1sts (utapid Property Values f4W% to 75% ( )Undar23SL study � (W . Predominant AcesP a ( uocreulag ()Oiraer ( t•blo ()DeeJlnlag. tltngteB•mtlyprlcoRaaco g to (Iq�snsat s_,'XtVacancy SlagleF•muygo� AY,. to --_—�rraao+ot�dr ;. Property Comp•tibiaty Good ( Fair Poor Protection ham DeWmeaW CoadidowGlinval rage (�1 of Properties bI Appeal to re �tnca () If If ) ( ) am O O Ughast And Hest Use (pdha eog Uee ( ) Othef Impromwats apau completion conform s ()YJZB Pabol WONOtbor �- ()rl0 BrieQy ducdbe Gad eats Electricity — _� Topograpby S 4►�/N� (gas Water -• c .s Sbape sawar —'s— vieer uadsrgr°and laectric & Te+tq*mm / —� Du sdaag• L Dnerdbe Visible eenmeab &Ugctlag proPolly.- Ia prepertq to • HUWdaagpsd Special 1Mlood 1Hazard Areal ()YY8 (1N0 KMQYANEM/� Mood lam Itdap Y D a Ssieflor 8atetiorconditim Good Aeorage Fall Poor Boo Iaterfar Condition Approx. (Arta O�erallT.habWly -- a0 — ( ) ( ) APprom Age (tflwdv#� . CmVA to 1"(S •rbood ( (} _ () ( r Comm- is lwtr)� f rn Itm — MA8 6 t /S'- 3•t� Cra I. Comparable No. 1 -�- Address m ]wean adieu inproper, Pro>hmity to sublet C ✓ ( )Equal Sak Ara �o�S'Q C� 0 ()InGrtor 2• Comparabland.2 Datadsils Z3-1- p2. Addrset ASS > %9►wKv�ITf ._ Prs O� �epsllsoatosabj op y (�up,rlof ( SaVPrice �-S7lcwo al 3. Comp dMAN .3 �� Daft Sala o ✓� S % ,eys O�varsll oomparls to � ve Price S� G[-C� eubj ctProp' (� r Proatvdty to sublott w w ti_ .y (�gaal � l W Date of Sde )I • a l • d Z iCsWa•tad eAs L" () "A1 Ceasplctad" ( ) va1•e of eubJeet propwb ae ot��; JiiC=2_ to � `� Q 04/11/2003 07:11 5085835477 PAGE 05 LOW E ' s 1BOC1(T69. RA c5onm-OOI7 SALES 1: 111741/1 601250 30620 216X1 IN DMICE 2 1 3.55 6001 21IX95 SPF SELECT 121 .1.91 11122 C81110 A0 1'1/1' 2160 760 d 6 PAIEL IN 106612 /ROSAul WK COTT 95431 VET 0 110101191 0." I 127.00NDt .97 7 T115� /THE HOME DEPOT 2680 39 LONO POND ROAD PLYMOUTH, MA 02360 CW8)830-6702 2680 00029 20684 03/29/03 SALE 32 419 08:56 AM 729111.ANil:TAAB,EKT, 2 1 11.17 SU111T1u 2ih16 TAX 301" : 4irU Q DWItE O21'J6 TOT1l: 22L9T J 1 U 0989=1775 1X5X8 PINE 4.75 098945051775 1X5XB PINE 4.75 IILANCE•DIIE: X9.21- 753593482509 DRIP CAP 0. 010306100274 1/2 SPACER 2.47 TOOLS VISA : 237.ii� 010306100274 1/2 SPACER 010306100274 1/2 SPACER 2.47 010306100274 1/2 SPACER 2.47 010306102541 SPACERS 4.9 VISA XIXXXXKXIIXX091 115301 764666143623 60 NAIL 5L ANOUKT: 227.2T VERSABOND - - -- 12.97 0101863OW40 VERSABOND 12.97 .-..- --- --- _----- ---_------------ 01018=840 VERSABOND 12.97 1174 TER111k: 62 0/27/0 15:28:51 / 724764810018 6XBFLOYMRD 6c 7�ml 25.000 9 $6.40 210.00 SUBTOTAL 279.22 279.22 TAX MA 5.000 13.96 X*00W� (XXXXX6398 TOTAL $293.18 VISA/MC 293.18 iNANK JAt011 CAIIIAlNO AUTH CODE 607584/9292121 TA FOR SWPPI91 LOVE'S RELEIIT REWIRED FOR CASH REFUND. C1m p111C8ASE REFUIOS REWIRE 1 15 DAY VAIT Pam FOR CASE RACK. STORE 0: RAIN11 ABBNIIIAI.L WE HAOE THE LOVEST PRICES, 6 AIARTEED I IF YOU FM A L01E11 MICE. W VU BUT IT BY IN. SEE STORE FOR DETAILS YOM OPINION COLINTSI COMPLETE A SURVEY AT WWW. HOItWOTOPINION. CON AND ENTER TO WIN A $300 HOME DEPOT GIFT CARDI 2) -7 e I 04/11/2003 07:11 5085835477 PAGE 06 4 4r HOME 5�E 287 899 COON (5081n3.0960 1OUNTON. MA 02780 2677 00001 14y90 05i26 tN 61 SALE L lr__m'- 73.00 i 301510Y0732 36X80 PRHM 73.OG• 0749 3 PRl1N F BB r 073291101671 2%11) H I.S7 07..911CI671 2X10-11 M'. 1.57 0 ,i S684114 On 2110 rl 1.2y iO3 15684104 OBL 2110 M ?� 8470Y 218 DOUBLE E 0443IS664102 %e „�.•a:i 1.29 ns,:i?�ka{7fIN• ' UUuo�t 9.97, . r 044113oe�11uB 66 LOCK 9.47 OSUI14671014 LOCK 9.47 050134273018 DOOR LUCK 1.90 050134973018 DO' TIE -DO 1.98 24 734884852454 24., IIE•00 1.90 734884852454 ..�pOTZ70-91 • .734�84852154 24 AL 355TAX•MA 5,000 • $224.46 ' YOUR OPINION COUNTS: COMPLETE A SUR'v%y L9.91 'TOTAL 6.16 AT UNW,HOMEOEPOTOPINION.COX AhD EIJTER -•.r,' GIFT CARD 70 WIN A 5300 HONE 0EP01 GIfT C,,RO) XJOcKXXXX5�+8 CARD BALfxCE THE HOME DEPOT 2577 9 TAUNTON, NA02780NT'/ STREET (508)823-09 e0 RETURN 2677 00017 05433 03/24/03 22 365 03:16 PM ""' REFUND " .v • 0.00 -. -- Z7B,30 '. - V15NMC iA YvY1rYXXXKx b 16283/ 401J574 '" `UUE � IIIIIIIIII�IIII�. 11111�IIIIINI� 77 1 159+4 0'3!1 • .E� 26 cou•rT51 COM�o T � EMTt / AplION j w6m NONEOEf0 ACNE DEPOT GIFT U�OI 10 Wlr A S300 / ORIG RECS 2677 001 14934 3/14103 " 030151020716 32XGO PRhN •71.CO TAX NA 5.000 -3.55 ORIO REC: 2680 002 $0339 3/23,103 032886166501 14/3U.f.M/ ••)2.27 TAX -1.62 -103,27 SUBTOTAL •101.27 TOTAL •5.16 XXXXXXXXXXXX6398 VISA/MC CR-108.43 8.43 INVOICE 4170403 l0TA TA TU REFUND �• CUSTOMER COPY �t d i ?q, 30.s, �3 s"3 a o O. O. mrONmODmmm ^.O^r4 V Grp J�Opp O O at gm rl N YY �'cr�_Fm�>Ssoogpc?_ n u5aC;, ig .0 ��rW e9000040►�Wmm�� f�i�.0 04/11/2003 07:11 5085835477 PAGE 07 THE HOME DEPOT 2677 /99 COUNTY STREET TAUNTON. NA 02780 (SOB)823-0960 2677 00001 35662 03/30/03 SALE 11 335 08:10 AN 022357454319 CEILINGNHT 022367454319 CEILINGWiT 724764010018 6X6FLOYNRD 724764010018 6)6FLOYNRO 724764810010 6X5FL0YNRO 724764810019 6X6FLOYNRO 724764010012 6XBFLOY)8IO 724764810018 6X6FL0YMRO 724764810016 6XSFLOYNRO 724764810018 6X6FLOYNRD -010166211800 25LO GRT9 080960SS3706 SANDSTONE '698960533705 SANDSTONE 088969SS3706 SANDSTONE 08896903706 SANDSTONE 028962553706 SANDSTONE 08826ISS3706 SANDSTONE 010306200274 1/2 SPACER 020306100274 1/2 SPACER 010306100274 1/2 SPACER 8.40 8.40 0.40 8.40 0.40 9.40 0.40 9.57 0.99 0.29 0.99 0.29 0.99 2.47 1 . THE H0399 LOW PPS RROOATD 2680 PLYFNOUTH. MA 02350 (508)830-6702 2680 00032 80339 03/23/03 SALE 61 425 03:20 AM 'AV /it 0511150.36835 MW TAPE p%,,J1! 716341100025 (3)MO PACK, 0843051.0459 RLLA TRAY viA 051Ni5421• IO KILZIIGAL 792203200645 TAPE MEAS 07617411.9114 UTI BLADES 07517'4119114 UTI BLOES 038662li0034 30 4/3U.F.V/ t 42)' 12.000 11 $5.29 SUBTOTAL 139.63 TTAX OTALA 5.000 VISA/MC XXXXXU-.'YXXX6398 AUTH CODE 60722415021179 5.0 9.87 2.57 11.93 4.98 1.47 1.41 63: Wi 6.98 .1+4G.Gi TA 2n80 02 80339 SUBTOTAL I 114.48 TAX NA 5.000 5.72 YOUR OPINION COUNTSI COMPLETE A SUIWEY TOTAL $120.20 120LU AT VYN.HOPEDEPOTOPINION.COM AND ENTER YISA/NC 120.20 TO YIN A $300 HOPE DEPOT GIFT CARDI AUTMtDOt)0016398 AUTM' OOE 607122/8073086.._ _ - _ TA - II IIIII�I�IUI�I��IIVNlllllllllllllllld�llllll &� T� % torL 2677 07 35662 03/30/03 8341 f_/ / S, YOUR OPINION COUNTSI COMPLETE A SURVEY 1D10 lV AT YYY.HOMEDE/OTOPINION.CON AND ENTER TO MIN A $300 HONE DEPOT GIFT CARD! 1 THE HOME DEPOT 2677 899 COUNTY STREET j� TAUNTON, MA 02700 (508)623-0960 2677 00001 19372 03/15/03 SALE 51 369 08:04 PN �J•�. U ? :761 .. op.;ij a51.ti3 C81092000270 1/2 4X8 GY 13.900 8 $4.99 64.87 774497666932 WNT CDR 2N 23.50 166081 08 5/e co 13.39SUB�y _ 91.76 TAX TNAA9 5.000 76 �,59 TOTAL ,S95.35 XXXXXXXYY7Yr��aa VISA/NC 96.35 04/11/2003 07:11 5085835477 PAGE 08 LOWE' S ., IROCKT011. •NA (50e)197-0061 -SALE- SALES 1: 11171111 194305 64-04-03 21042 GENTILE NIPPER!! 11.36._ ! , Sg7i.62900�,1'I�IY.Q1} 1,1�'• rOLtiS 21M NU AINMPLWA ;- 4.PT 1192Q iluli F ik To MI 124503 7" NET SAN 10061 1205 111 FLOOD m to 51.14 21 25si 29469 3/10" READY TO PA 79.16 4.0 •17.m 17312 ip" TTLEIAI CEAI 23/.25 11-V AL 1S 1 15.91 1667/ TNIAXET ANE1 75 1.11 ( l 3�9.ro SIAOTITAl: 4N.23 TAX 3A1n 1 ' 24.21 DROIM 02723 TOTAL: -51149- + ✓�. 0, I Z L-OWE"S BROCKTON, AA (SOI)197-0067 -SALE- SALES 1: S1174JLS 257793 96321 3/16, JUBILEE NNI 5 1 17.54 1311" 1112111 EVP Fin S 31173 /L.INT/EKT H.a.1 21 21.95 110413 RL.F0111I0E IAT.1 2 1 10.97 70974 MOM-10:T. WALL 501 4 1 0.66 70111 CABLE COP 0 250, Y 1 19.16 971M TF 10" TAPING Gi 911957 12" TAPIRI 91 11776 USA PLUS 3 AEADt' SUOTOTAL: TAX 311" : IlA10ICE 02067 TOTAL: IAIRACE DUE. SAD./? 1d ,y TRr BALAACE DUE: - -- - - VISA : S°1`lq —Al, -ln Ulm XXXIItXXIX=l I , 119195 ARM: 50909 • 1174 TEANINAL: 02 04/04/03 20:11:41 11111111111IN01110111 TIN You JASON CAAu" FOR SilOPJ m IONE.'s . u . RE[EIPT Rf�I11�F0[LASN REF111D. .NECK PURCHASE.REFM AEOVIRE 15 MY PAST PEIII00 Fp CM NO. si0AE 0: IAIHO A1111AW E WE HAVE THE LOWEST PRICES, IUARANTEED! IF YOU FIND A LOW PRICE, WE WILL BEAT IT BY 10t. SEE STORE FOR DETAILS u VISA : 04.01-03 0.70 12 92 TA1►� 3.52 32.92 (!P,T�j TUt Alt 2� Fir11 z 1S3.310 R1S:24 uu4 /(o 7�!+ en - VISA XXXXMIXIXX0391 /16015 ANOINT: 245.24 1174 TERNINAL: 02 04/01/03 17:07:31 THAN['YOU JASON CARNOLKQ FOR SNOPPIN LOVE'S RELEPT REAOIRED FOR CASH REF11110. CHEM PURCHASE REFUNDS AEQUI➢F 15 DAY WAIT PERIOD FOR CASH BACK. STORE 0: AABHU ABAANWALL WE HAVE THE LOWEST PRICES, GUARANTEED! IF YOU FINO A LONER PRICE. WE HILL BEAT IT PY lot. SEE STORE FOR DETAILS 04/11/2003 07:11 5085835477 PAGE 09 C DEP07 2677 COUNTY STREET 2780 (608)823.0960 '7 OOO/ 03 61 5e335 03s54PM 12X78 PRHN 71.00 NXeX3/e SR 5.29 0.99 Lime CB 1l/4X8 CB 0.99 11/4Xe CB 0.99 11/011 C8 0.99 SANDSTONE 29.70 29.70 SANDSTONE SANDSTONE 29.70 SANDSTONE 29.70 ON SANDSTONE .29.70 MIME 29.98 OUTLET BOX 0.48 OUTLET.BOX 0.48 OUTLET BOX 0.46 OUTLET BOX 0.48 OUTLET BOX 0.41 OUTLET BOX 0.48 OUTLET BOX 0.48 OUTLET BOX 0.48 OUTLET BOX 0.40 1 OUTLET BOX 0.49 1 OUTLET BOX 0.46 1 OUTLET BOX 0.48 1 4 GANG BOX 3.92 ) BEIGESLATE 0.99 3 BEIGESLATE 0.99 3 BEIGESLATE 0.99 0 BEIGESLATE 0.99 0 BEIGESLATE 0.99 0 BEI6ESLATE 0.99 0 BEIGESLATE 0.99 0 BEIGESLATE 0.99 .0 BEIGESLATE 0.99 .0 BEIGESLATE 0.99 SUBTOTAL 218.81 TAX MA 5.000 10.94 TOTAL $229.75 VISA/MC 229.75 9X6396 61459114020438 TA Q�6t �- �{ US.13 LOWE'S BROWN. MA j (506)197.0067 -SAu_ SALES 1: 6117413 257793 0445-03 0567 1' PVC. DIVISM IAR 20 1 2.11 95040 CRYSTAL MITE COV 1 1 2A2 17312 1/10 TILEW CM 3 1 15.93 i 45546 GL KILL It f2W I SOITOTAL: TAX 38119 : TAVOICE 02049 TOTAL: p IIIIIII�IIIIII nl DIIII�II�IIIIIII III ' 02 38369 03/2 / IIOM COUNTS! COMPLETE A SURVEY (NNS EOOTMOK DDEE1PO.CON AD T GIFT CARDIR INJM DUE: VISA 43.40 2/.06 47.79 u ..T3 178.]L OL34 3� VISA XXIXXXXXXIUM98 SM25 ARM: 130.34 1174 TEAMIMAL: 02 44/05/93 21:41:40 illigilloolmilim . RECEIPT 'REQUIRED FOR tASN OEW- CHECK PIR m .REFMOS IE .= 15 MY MIT KIM fill C41111 MILK. $TVs 0: MBI10 Mmmi VE MOVE TIE UYEIT•PIIICES. ri1WTEED! IF YOU FIN A LOQED PRICE, VIE PILL PEAT' IT 1Y in.:SEF STORE FOR DETAILS 0 i ` LOWE ' S BROCKTBY,•M (51A)891-1067 SALES 1: 1: S11?4T02 13 03.18-03 11730 GYM 08 1/2 11 70 . 4.99 11770 M PLOS 3 NAVY 45%1 GAL KW Pp 0 3 1 9.18 SMS2 9111 1401 /AIDE-C 2 1 2.11 SSB50 9X11 ALUM OXIDE F 21 2.17 SVITOTAL: TAX 38189 : DNQICE 82199 TOTAL. 34.23 154 P�7�T 4.34 4.34 83.10 4.15 .81.29 BALANCE DUE: 17.26 VIM; 0.25 VISA x==Dmxmm 615395 AMOUNT: 17.29 1174 TMVA: 02 .13/11/03 16:38:35 smog Twx YOU .N= MALMO FOR OWING LOVE'S RECEIPT REIVIR D FOR CASH REFUND. CHECK PURCHASE REFUNDS REQUIRE 15 DAY WAITmoo FOR an 1ACI. 'IT011li mi: Nm..#NIIIu VE MAVE THE LOVE'T PRICES, WARAKTEEO! IF YOU FIND A LOU MBE. 1E BILL PEAT IT BY 104. IU STORE FOR.IETID.S e 04/11/2003 07:11 5085835477 PAGE 10 Carlson Electric Robert Carlson Master Electrician # A16945 39 Nauset Road West Yarmouth, MA 02673 (508) 771-7691 Bagels and Beyond 311 Rt. 28 West Yarmouth 508-790-8500 Bagels and Beyond 311 Rt. 28 West Yarmouth 2 2 3 phase panel 3TBBZA1242C $299.65 $599.30 1 1 3 Phase meter socket U2594-X S268.50 $268.50 Customer paid in full direct to supplier. No charge for install. Items: $867.80 Freight: S0.00 Tax: S0.00 Total: S867.80 04/11/2003 07:11 5085835477 PAGE 11 Rpr 09 03 02t17p Jamas M. Pazakls 5063852712 P•dF P. I c� 2 ZfPa:akisl'lumbing(d)aubi. com April9, 7003 Dear Potential Customer, Prgwrty /►gated At: 311 Main St. West Yarmo 0h, Ma / hereby praprave to: histall l (wae) tie w th►ve bay "pot shaft ", with an adjacent hwul sink, install owners hand sink in, front "counter area " drained by a xhellbaek pump system, all fixtures to be owners supplied and reused front the adjacent exislMR restaurant h►ch►ding the brstallatimi of a "utility "shut snpplied by the em-ner. %his price to also include the installation of owners supplied Grease trap ailached to three bay ' pol sink" Me use of type L Wrought copprr on all potable waier supply comuectiews The use of type M tubing with "dwro" type ftttings oat drai►uage cattnectio►u The use of "no hub" cat iron pipe and fittings far the connection to the existing piping %he use of all required safety devices as required by Mass. Cade 148 C.M.R The above equipment will he imialled far the price of ,S —Z / 7b.00 1.i down wish sig►ted contract in she amount equaling S-1, 088.00 15 Due apon cumpkllon ofJob in the amount Equaling S--1.088.00 04/11/2003 09:28 5085835477 PAGE 01 BAGELS F,BEYON➢ Tpfir g 214f-0616 327 Main Street W. Yarmouth, MA 02673 508-790-8500 Freshly Baked Bagels Made From Scratch Everyday!! FROM: dun, "V �S'tl efts ��4�cs'F� RE: 9Z -4s TAcUjwt.,I 6 ObidL 04/11/2003 09:28 5085835477 PAGE 02 April 10, 2003 Kenn Bates c/o Yarmouth Building Department: I am enclosing the estimates and costs pertaining to 311 Main Street. I am also enclosing the estimate for the second bathroom �e��The would be all necessary materials have been purchased and the only . mere incidentals. Your are welcome to take a tour of the project so you can see for yourself. The breakdown is as follows: Receipts Of Materials Purchased $2,806.29 Hood System Required By Chief Raskin $2,200.00 Plumbing For Sinks Etc. $ 7176.00 2 9 Total Project Cost Estimate For Second Bathroom (assuming That this was done from the beginning of 3 .0 Project) Total Project Plus Estimate $10,578.29 As you can see that this does fall under the cap of $12,000. I also took your advice and attained a copy of the assessment of the property, which my lender performed, last February. Unfortunately the valuation combines both land and building, but based on the percentages that the town uses we can figure out the building value. Town Information: Total Value 1649000 100% Building Value 4%000 (24%) Land Value 1249400 (76%) 30% of40,000 = S12,000 Appraisal As Of February 18, 2003 Total Value 290,000 100% Building Value 69,600 (24%) Land Value 2209400 (76%) 04/11/2003 09:28 5085835477 30% of 691,600= S209890 We are not only under the value for the Town figures but we are extremely under value for the updated figures of just two months ago. I hope this take care of the concerns of the second employee bathroom, I apologize for the inconvenience of this issue but, as you are aware, we were not privy to any 'bathroom' issues when this project was taken on. please call me directly if you have any questions or further concerns and thanks for your time. Jason Carvalho Bagels & Beyond 508-790-8500 PAGE 03 vEerty Location: 311 ROUTE 28 AIAP ID: 30/ 26/ / / Valon ID: 3724 Other ID: 25/ B007/ / / Bldg #: 1 Card 1 . of 1 PH& Date: 04/07/2003 05 CURRENT O WXER TOPO, U77LI77ES STREIROAD LOCA77ONSSESS ENT ENNESSEY, GARY VASHE, MICHAEL P 746 NEST MIDDLE TURNPUM iANCHESTER. CT 06040 onal Owners: Desert tton Cods lAvvrolsedValue Assessed Value ells YARMOUTH, COMLAND MMERC. :1 MERC 3220 3220 3220 124,400 34,700 5,300 124,400 34,700 5,300 sf 6,G 5o7" 1 1 SUPPLEAL # 0373200 ubdnision 190 WordPrecinct ISM. VISIC Total 164,4001 164,.00 RECORD OFOWNERSHIP BK-VOLIPAGE SALEDATE s4 SALEPRICE .G PREt rOUSASSESSM IS fffMH11S 0 ENNESSEY,GARY H LAIAIR ERIC 1246QI292 08/06/1999 U I 217,000 0 1C Yr. ICode Assessed Value Yr. Cads AssessedYalue Yr Cods Assessed 2003 2003 2003 3220 3220 3220 124,400 34,700 5,300 002 002 002 3220 1220 3220 124,400 34.700 5,300 001 001 001 3220 1220 3220 ra • 164,400 164,400 EXEMP77ONS 0 ER ASSESSMENTS This signature acknomfedges a iisit by a Data CoUedor or Ass Year nreVescrfpffon Amount Code I Descrt tton Number Amount Comm. Int. APPRAISED VALUESUALWRY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraised OB (L) Value (Bldg) Appraised Land Value (B dg) Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: Cost/Marl:et V ra NOTES CAPE COD TOBACCO FORMER PELLA NINDOW STORE et Total Appnlsed Parcel Value BUILDING ER 19 RECORD S /C 'GEHISTORY Permit ID Issue Date Dew yHon Amount Ins .Date % comy, DottyComp. Comments Darr I 1D Cd. I PurvomvRes 998" 2/24/1988 2,000 100 REPLACE W 10/5/1995 M11 00 leaearhLided D LINE KMALUTIONSEC77ON B# Use Code Description Zone D nra a I Depth Untts UntrPrtce 1, Factor S.I.C. Factor klbhd. Adf. Notes- AdPSDeclal Pricfn2 Ad , Untt rice Land V 1 3220 STOREISHOP 20,037.60 SF 2.70 2.55 K 0.90 1.00 0•k TOPO 6.21 Total Card Land Unite 20,038.00 1 SF Parca1Tota1=dAr*a:j 20,0.78 SF Total Land Vale Prbn D.�4 ion: 311 ROUTE 28 ALIP ID: 30/ 26/ / / Other ID: 25/ B007/ / / #: 1 Card 1 of 1 Print Date 04/07/2003 09 xtaior Wall 1 2 Suucwm Cover or Wall 1 2 nterior Floor 1 2 eating Fuel eating Type n'Pe Rooms .1SryIe Story rood Shingle Alr-no Due e r Bedrooms r Bathrms YARD ITEbfsa D FILME AGE ds \VALLS %Common Wall D Wall Hai& COADO/dfOBILE MOhfE DATA ;Jnit Location Vumber of Units Vumber of Levels %Ownership O T/11 E V U O ase Rate S0 00 . Factar 135000 Index 0.98 e Rate lue New 66 is 91.297 ilt 1968 r Built raa'Bldg 1979 yscl Dep balno 42 0 clnc 20 onA Code nd %Good. 38 B1d8 Value 34,700 9,04.YgR� Building Site Location: Proposed Improvement: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF i._ k _ 11__1 V ; _ 1 . No: 30 Lot No: 676 The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. WATER DEPARTMENT: ENGINEERING DEPARTMENT: CONSERVATION COMMISSION: HEALTH DEPARTMENT: FIRE DEPARTMENT: REVIEWED BY: RESIDENTIAL AND/OR COMMERCIAL BUILDING Determines Compliance of Water Availability and or existing location. Determines Compliance for Parking and Drainage. Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta 1. WATER DEPARTMENT: DATE: N/A 2. ENGINEERING DEPAR T: Of DATE: N/A: 3. CONSERVATION: DATE: %- xy`03 N/A: 4. HEALTH DEPARTMENT: DATE: N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR DATE: N/A: 7. FIRE DEPARTMENT: DATA: N/A: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: WhM CM - Buildog DcPL - Pick copy - W.w Dept - Ydlow Copy - Halth Dept - Pick Copy - E4=a4 Dept - le- Fire 4o YAR-��'TOWN OF YARMOUTH ° BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: A No: �'G LotNo: O .z-/L! /D-,: The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parldng and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: I. WATER DEPARTMENT: DATE: NIA 2. ENGINEERING DEPARTMENT: DATE: N/A 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT. DATE: N/A INDUSTRIAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR DATE: N/A 6. PLUMBING 7. FIRE RECEIPT OF COPY: SIGNATURE OF PLEASE NOTE N/A %Ike copy -130dingDcpC- PiokcM-W&WDcpL - YcuMUW-HmMDepL - K& Copy -> �DepL 1,.. d F( ircAe oascration ....�-....-,..�...,,r,,,-.,,�:r-,,,��,-,.,,,y....+�...•...-+,r-+-.---•w.a�ai.,..,i•�,.,�-,,,.,.,.,ert,,,.,,.,.�,,..,�r....✓.- ..�w._..r.-�.�.✓----...w..ra+.�v.►.-•� 4" Building Site Location: Proposed Improvement: TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET No: 3o Lot No: a 6 Address: S (./��?_p�7i �LTeLNo.:� r .L L' / The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: - N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A: 4. HEALTH DEPARTMENT -. _DATE: 20 0 N/A: INDUSTRIAL AND/OR COMMERCIAL PERMITS S. WIRING INSPECTOR DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A PLEASE NOTE COMMENTS:/. � //j�/ �.y� /J J� /. (. L' _ / C '�-j/{'//��/ /�/ �// � ('/��/. � � /{/� I /� �0 /w �A 0� T 6)r 1, T / /3 l /✓KLlil a r� ✓�WV • ^ . I x7 —a &0/ 1Qa-�/ RECEIPT OF COPY: SIGNATURE OF APPLICANT: n DATE: White copy -Buddm6Dept - Pinka)py -Water Dept. - YcRawCopy - He" DTL - - Enin=4DgL Goldenrod -Fire DcpWmacvition TOWN OF YARMOUTH Building Department Town Hall Yarmouth, MA 02664 (508) 398-2231 94261 BBUILDING PERMIT APPLICATION RECEIPT Temp Permit No.: T-03-358 Applicant Name: Christopher Lee Location: Owner's Name: 00311 ROUTE 28 Jason Canvalho Owner's Addres 327 Route 28 West Yarmout MA 02673 Owner's Telephone: (508) 790-8500 (OFFICE USE ONLY Recorded By. Ic Permit Fee: $0.00 Deposit Rec: $25.00 Payment Type: Cash ChkNo.: 0 Net Owed: ($25.00) Application Date: 2/21/03 Issue Date: Expiration Date Comments: �p interior alterations: remove two non -bearing walls & part of bearing wall, create opening to outdoor freezers, add bracing in attic This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee. Date Printed: 2/21/03 Property Location: 311 ROUTE 28 MAP ID: 30/ 26/ / / Vision ID. 3724 Other ID: 25/ B007/ / / Bldg #. 1 Card 1 of 1 Print Date: 02121700313 e verage a Type 12 WOODFRAME athsMambing 2 AVERAGE � Story pancy, 'ling(WaB 1L & WALLS ooms?= 2 AVERAGE for Wall 1 4 Wood Shingle Common Wall 2 Wall Height Structure able/[Bp Cover h/F GIs/Cmp CONDO/MOBILE HOME DATA or Wall 1 2 aivsheet ement Code Descnption F, nq)lex or Floor 1 4 2 loor Adj nit Location ng Fuel 3 3 as Iot Air -no Duc umber of Units � 1 one umber of Levels Ownership Doms Bedrooms COST/MARKET VALUATION moms Bathrms Total Rooms nadj. Base Rate 50.00 ize Adj. Factor IM000 Bath Type rade (ty Index 098 Kitchen Style dj. Base Rate 66.15 Idg. Value New 91,287 ear Built 1968 Year Built 1979 rml Pbyscl Dcp 42 oa 0 MIXED USE slnc n n Obstnc pal. Cond. Code 20 3220 RE/SIIOP 100 3pecl Cond % verall % Cond. 38 )cprcc. Bldg Value 34,700 OB-OUTBUILDING & YARD ITEMS(L) I XF-BUILDING EXTRA FEATURES(B) Code Descri tion I LIB I Units I Unit Price I Yr. I Do Rt I %,Cnd I A r. Value PAVI AVING-ASPIIALT L 9,000 0.901994 0 50 4,100 SGNS ANT LIGIM I L 1 25 77.00 1987 0 60 1 1.200 Property Location: 311 ROUTE 28 AfAP ID: 30/ 26/ / / Vision ID: 3724 Other ID: 25/ B007/ / / Bldg A: 1 Card 1 of 1 Print Date. 02/21/2003 13:09 CURRENT OWNER TOPO. UT/LTTIES STRTJROAD LOCATION CURRENT ASSESSMENT 815 YARMOUTH, AM iENNESSEY,GARY ASIM MLCIIAEL P 7461VEST MIDDLE TURATUCE MANC1W.STER,CT 06040 Additional Owners: Description Code Appraised Value Assessed Value #EE COM LAND COhflAERC. COMEERC. 3220 3220 3220 124,400 34,700 5,300 124,400 34,700 5,300 SUPPLEAfENTAL DATA Account # 0373200 ubdivision 190 oto Nard ct IS ID: VISION Total 164,400 164,400 RECORD OF OWNERSHIP BK.VOUPAGE SALE DATE gly vR SALE PRICE vc PREVIOUS ASSESSMENTS H/STOR HENNTSSEY, II.LMAIR ERIC 12460/292 08/06/1999 U I 217,000 0 1C Yr. Cade Assessed Value Yr. I Code Assessed Value Yr. Code Assessed Value 2002 2002 2002 3220 3220 3220 124 400 001 34,700 001 5,300 001 3220 3220 3220 124 300 34,700 5,300 2000 000 00 3220 3220 3220 SU00 36,100 S,300 Total: 164 400 Total: 164,4 Total. 124,20 EXEMPTIONS OTHER ASSESSMENTS This signature aeknow1edges a visit by a Data Collector or Assessor Year /Descrition Amount Code Description Number Amount Comm Int. APPRAISED VALUE SUMAIARY Appraised Bldg. Value (Card) Appraised XF (B) Value (Bldg) Appraised OB (L) Value (Bldg) Appraised Land Value (Bldg) Special Land Value Total Appraised Card Value Total Appraised Parcel Value Valuation Method: 34,700 0 5,3W 124,400 164,400 164,400 Cost/MarW Valuation Total: NOTES CAPE COD TOBACCO FORMER PELLA WINDOW STORE et Total Appraised Parcel Value 164,400 BUILDING PERMIT RECORD VISIT/CHANGE HISTORY Permit ID Issue Date Type Description Amount Insp. Date % CmV, Date Comp. Comments Date ID Cd. Pu sdResult 99886 2/24/88 2,000 100 REPLACE W 1015/95 hill 00 teasur+Listed LAND LINE VALUATION SECTION BA Use Code Description Zone D[Frontagel Depth Units I Unit Price L Factor I S.I. I C. Factor Nbad. I Ad . I Notes- Ad' vial Pricing Ad]. Unit Price land Value 1 3220 STOREISHOP 20,037.60 SF 2.70 2.55 K 0." 1.00 0%TOPO 6.21 124,400 Told Card land Units 20,03&00 SF Parcel Total land Ana: 20,038 SF Total land Valu 124,400 /� b3 TOWN OF YARMOUTH BUILDING DEPARTMENT BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Building Site Location: Proposed Improvement: No: 30 Lot No: a Filed: / 3 The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following applicable departments. RESIDENTIAL AND/OR COMMERCIAL BUILDING WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location. ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage. CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., if Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc. REVIEWED BY: 1. WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A: 3. CONSERVATION: DATE: N/A 4. HEALTH DEPARTMENT% DATE: N/A. - INDUSTRIAL AND/OR COMMERCIAL PERMITS S. VIM NG INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: PLEASE NOTE COMMENTS: RECEIPT OF COPY: SIGNATURE OF APPLICANT: N/A: DATE: White copy - Bua"g Dept. - Pmk oDpy - Water DepL - Yellow Copy - Hc&M DcpL - M Copy - Eng�g D� - G� - Fut DcOAConscrvatm :43 C`'lR. BOARD OF STATE E\AA%UNERS OF PLUMBERS AND GAS FITTERS 2.10: continued (I8) Minimum Faciliti-s for Dwellings. Whenever plumbing fixtures are installed, the minimum number of each type of fixture shall comply with the requirements of 105 CMR 410.00 (State Sanitary Code, Article II, Minimum Standard of Fitness for Human Habitation), and shall conform with 243 CMR 2.01(7). (19) Minimum Faeilititi s for Building Oecu:::!ncv Other Than Residential a A .-Uation of Standards and Fst hlkhir, O +nan^y 1. Applicability of Changes: the requirements set forth in 248 CMR 2.10(19) and Table 1: Minimum Facilities for Building Occupancy shall apply only to plumbing system installation, alteration or extension projects in which the process of designing the plumbing work to be performed begins on or after the date on which these new requirements are published as final in the Massachusetts Register (June 3, 1994). 2. When determining the number of plumbing fixtures after the population has been established by the authority having jurisdiction, should a fraction occur, round up to next fixture. (b) Classification of Places of Assembly. I. Asserhly (,general). All places in which alcoholic or non-alcoholic beverages are sold, or offered for sale, to be consumed on the premises; any room or space used for public or private banquets, feasts, dances, socials, card parties, weddings or for lodge or meeting halls or rooms; skating rinks, gymnastics, swimming pools, billiard, pool, bowling, and table tennis rooms; halls or rooms used for public or private catering purposes, funeral parlors, recreation rooms; broadcasting studios; private clubs and all other places of similar occupancy shall be classified as general places of assembly. Restrooms for each sex shall be provided in the amount specified in 248 CMR Z.10(19)Table l for assembly. 2. Asvmh yj .P li at dl. a. All places of worship, arenas, stadiums, theaters, cinema, restaurants, pubs. and nightclubs shall be classified as dedicated places of assembly. Restrooms for each sex shall be provided in the amount specified in 248 CMR 2.10(19)Table 1 for dedicated assembly. b. Where the capacity is more than 2,000 persons, the number of toilets for the first Z,000 persons shall be calculated using the ratios in 248 CINIR 2.10(19)Table 1. For the number of persons in excess of 2.000, the number of toilets shall be calculated at ratio of 1: 100 for women and 1: 200 for men. c. In restaurants, pubs and nightclubs where the total number of employees and patrons which can be accommodate at any one time is less than 20, and the total floor space is less than 1,200 square feet, the provision of one unisex, handicapped - accessibie toilet for use by both employees and patrons shall meet the minimum. requirement. 3. Nothing in 248 CMR 2.10(19)(b)2.a. through e. shall apply to single or multiple family dwellings, or to a place of incarceration or detention, a convent, or a monastery. 4. Plumbing fixtures for employees shall be included in 248 Cr1R 2.10(19)Table 1 for this type of occupancy. 5. When the occupancy ratio of 50% for each sex is not used to define fixture counts, the local plumbing inspector shall be notified in writing, indicating the occupancy of each sex for the purpose of establishing fixture amounts. 6. Any building having embalming facilities or autopsy facilities shall have a flushing rim sink and a floor drain. (c) Assemhly Macs of\Vora in - Church%mnyn +Z et etc-). 1. in no case shall there be less than one water closet and one lavatory provided for each sex to accommodate worship service area. 8'9/96 249 C% R - 70 1 24S CNIR BOARD OF STATE EXAMINERS OF PLUbffiERS AND GAS FITTERS 110: continued 6. All secondary and post secondary schools that conduct sporting or physical activities on school premises and/or have a gymnasium in which said activities may be conducted. shall have separate showers for each sex to accommodate students. All schools which have trade type programs in which student may become soiled, shall comply with 248 CMR 2.10(19)(h)6. 7. Deluge showers shall be installed in every school chemistry laboratory classroom, or any room used for similar purposes wherein flammable liquids and open flame devices are used in conformance with the most recent 527 CMR adopted by the Board of Fire Prevention. (i) Frrp!oyee Faeilities (Non -Industrial). 1. In each establishment where people are employed, there shall be separate rest rooms for each sex, located in each establishment and shall be plainly so designated. 2. Facilities in establishments referred to in 248 CbIIt2.10(19)G)l. within two branch levels shall be acceptable. Facilities shall not be required for mezzanines.. See 248 CNR 2.03: I�1�. 3. Unisex toilet rooms are allowed if they meet the requirements of 248 ChfR. 2.10(19)(m). 4. In business or commercial establishments (except industrial) which contain less than 1,200 gross square feet of floor area or does not have reasonable access (within 300 feet and on the same floor) to core or common facilities, one toilet room located within the establishment with the number of fixtures according to the standard set forth in 248 CNM I10(19)Table l for employee facilities, shall meet the minimum requirement. 5. In every establishment where only one person is employed or works, there shall be one water closet and one lavatory for use of its tenant, provided within reasonable distance, not to exceed 300 feet. Core or common facilities within reasonable distance (defined in 248 CNIR 2.10(19)(1)4.), located on the same floor as the establishment being serviced and having separate designated facilities for each sex, may be used to meet the requirements of 248 C,%M 2.10(19)Ci)5. The number of fixtures in the core or common facilities shall be according to 248 CMR 2.10(19): Table I for employee facilities (non- industrial). 6. Where core facilities are allowed and in compliance with the code, additional designated toilet rooms shall be allowed within the establishment. These fixtures shall not be credited to the requirements of 248 CMR 2.10(19): Table 1. Employs Facilities (Industrial) 1. In every industrial establishment, all toilet room facilities including the number and type of plumbing factures, the floors, walls, windows, ceilings, lighting, ventilation, doors, partitions, design and location of toilet rooms shall comply with 454 CNIR 2.00: Toilets in Industrial Euablishments. . 2. Separate toilet rooms shall be provided for each sex and shall be plainly so designated. See 248 CMR 2.03: MP77anir 3. The number of water closets and lavatories shall be provided within reasonable access (defined in 248 CMR 2.10(19)0)4.) and in accordance with 248 CNIR 2.10(19)Table 1 for industrial facilities. 4. Reasonable distance for industrial establishments shall comply with the following: in no case may a water closet be located more than 300 feet distance from the regular place of work of the persons for whose use it was designed, except where service elevators, accessible to the employees, are provided. 5. Each 20 inches of usable or circumference 18 inches sink will be considered as an equivalent of one lavatory. 6. In special industries of departments where there is undue exposure to poisonous substances or liquids or where the work is especially dirty, one lavatory or sink may be required for every five persons and in all cases, a potable water supply of hot and cold water shall be provided. (k) Medical and Health Care Building Fa iliti t• 1. In all medical and health are buildings there shall be separate designated toilet facilities on each floor for male and female patients and visitors. 2. The facilities may be located in a common or core area on each floor that is within 300 feet of all offices. 3. Accessibility shall be direct, it shall not require going from one medial office through another. 919/96 248 CMR - 72 J 243 CaMR- BOARD OF STATE EXANIIhERS OF PLUMBERS AND GAS FITTERS 2.10: continued 4. Handicap facilities are required on each floor. 5. A minimum of one drinking fountain shall be installed for each set of toilet rooms. (1) Covered hfalk. 1. In all covered malls there shall be separate designated public toilet facilities for male and female, centrally located in the common area on each floor. 2. These facilities are in addition to the requirements of 248 CMR 2.10(19)(i) regarding toilet facilities for male and female employees. 3. When occupancy exceeds 9,000, water closets shall be installed at the rate of one per c, 1,500 for women and one per 3,000 for men. Lavatories shall be installed as listed in 248 CMR 2.10(19)Table 1. J' µu (m) 113n .i an Fa ilily Requirement. Facility for the physically handicapped person: t nC t L' 1. Fixtures shall be installed in conformance with 521 CMR 3.30.0 Public Toilets (for fixtures dimension requirements only). 2. When public rest rooms are installed, handicap fixtures shall be installed to comply with the requirements of 248 CNIR 2.10(19)(m). 3. Unisex handicap facilities are allowed when approved by the Board through a variance process as indicated in 248 CMR 2.01(1). a. A variance is not required if the fixtures in an existing or proposed men's and women's room and the fixtures in a unisex handicapped toilet room meet the minimum fixture requirements in 248 CMR 2.10(19): Table 1. A unisex toilet may be counted only once toward the total minimum fixture requirements. b. These facilities shall be kept clear of obstructions at all times in accordance with 105 CMR (the sanitary code). 4. Wherever drinking fountains are provided. at least one drinking fountain shall be accessible to and usable by person in a wheel chair. (n) Rest Rooms General. 1. Toilet rooms accessible to the public which have two or more water closets or urinals, or two or more the -roof in combination, shall have a floor drain and a valved hose bibb connection equipped with an approved backflow preventer for the purpose of flushing andlor sanitary hosing. 2. Floor drains shall be of an approved design and shall be installed in the vicinity of the urinal(s) and at a grade to permit floor drainage to it from all directions. 3. Water closets for public use shall be of the elongated type and seats shall be solid plastic, non -pores of the open front type. Refer to 2.10(6)(a) through (f). 4. When a urinal(s) is provided. floor areas to one foot in front of the urinal lip and one foot on each side of the urinal and the.wall areas to four feet above the floor, shall be furnished so as to be non -absorbent. Wood and fiber boards are prohibited in these areas. Refer to 248 CUR 2.10(7)(c). S. Ina room with more than one water closet, or with a water closet and a urinal, each water closet shall be enclosed. Each urinal shall be side shielded for privacy. 6. When two or more urinals are required a shield shall be provided between urinals. (o) I anndties. T. One clothes washer hook-up shall be provided in dwellings for single residence. 2. A minimum of one clothes washer hook-up shall be provided in multiple dwellings for each ten apartments. 3. One laundry tray or washing machine for every 20 apartmenu or fraction thereof, shall be acceptable in housing for the elderly. (p) Trinal%. 1. Urinals may be substituted for water closets where indicated in 248 CMR 2. l0(19)Table I are listed by percentage. 2. Urinals listed for elementary, secondary, post secondary and industrial factory/warehouse are in addition to the water closets required. 3. When urinals are used at lout one shall be set for handicapped use. (q) nathreom Group Defined. a bathroom group shall consist of one bath tub or shower stall, one water closet and one lavatory... _ 8/0/96 248 C`iR - 73 0 O v W. 0 9 T O 0 1J A o� n J 4 BuildintClanlrcation see we 1 Use Group Water Closets Unnall Il.tes lavuotin Each Sac Drinkint Founuin Bath,' Shower Oil." Fatures Notea 2-IS Chtlt 2 1009) Fenula Maln Theaters A-1 1 r 30 1 r 60 50% I r 100 1 •r IOM I service sink r �`H b . (ill. (in). nl. ( ) Niahtclubt Pubs A•2 I r 30 1 r S0 SO': 1 75 I r Soo- b .(m). n Restaurants A-7 1 pet 30 1 per 60 50% 1 r200 1 per Vol 1(m), n I tan, Muarums. EIe. Ad 1 mr SO 1 per 100 SO': 1 Per 200 I per IWO b . fill. (in). W. Coliseums Arenas A-1 1 pet 30 1 per 60 W..: 1 per 150 1 per IMlO b) i I. rat n. I"w orworship A4 1 perSO I mf 100 106N. I per200 1 lwt IDOO b , c m), (n). ( Stadiums Pool Et. A•S I per 30 1 Pei60 SO'. 1 per 150 1 per I WO Bathing (Public Beaches I per 200 I mr son 31% I r IWO I rwf IOM I mr 1000 1 Service Sink mil n Day Care Facility (Child) (Staff) E-1-3 1 Per 20 1 per 20 I per 20 I pet 73 I Service Sink (e), (m). (n) NA 1 per30 I per2S 33% 1 prr40 (),(m), W.(p) Detention Facility (Ocuince) (surf) 1-3 1 per6 I Pa S 33% 1 per 6 1 r t M (m). (p) N/A 1 per20 1 1 per 25 33% 1 per JO M.(m),(it).(P) Dwellings (Sintle) - (NIAPte) R One 1lathroan Group anJ One Lichen Sink - (0), W R One Bathroom Group and One Kitchen Sink per Unit (o), O Q1olctllofeD (Dormitories) R - One Bathroan Group rcr Unit - - (14W R-2 1 rrr 6 I per S 331. I Per S 1 Per 73 - 1 per t 1 Service Sink Fluor (t), (m), (n), (P) Eduutiorul (Kindcrtarten) (Elernenury) (Secondary) (PostSeetimary) .0 E 1 per 20 1 per 20 1 per 20 1 M 73 I Service Sink Per Fkwr (h), O), On), W. (p) - E 1 per 30 1 per 60 1 Pcr 60 1 pet 60 1 M 73 E 1 Prr10 1 per90 I per90 1 per90 1 per73 E 1 per90 1 per 190 1 per 180 1 Pee ISO 1 pet73 E 1 rcr20 1per25 13% 1per 10 Empkryee (Non-lndustnal) I per 20 1 per 25 330; 1 pct40 I Pc1 200 1 per 130 1 Service Sink mr Floor (), (m). (n). W Emplu)es (Industrial Factory/ Warrhouse and Similar Ussee F I per 13 1 Pet 20 1 Iwr •10 I her 30 1 Pcr 100 1 (et 15 O, (m), (n), (p) 1J O 0 0 ap C a Buil, mg Clarificuion Use Cmup Water Clouts Utinals Lavaumes Dnnkirj 0111J Other Nutcs See Note 1 Malcs Each See Fountain Shower Ficturcs 24S CMR 2.10(19) FemalesMtla Institution 1 1 per Rnum I per Rm 1 per IS 1 Service (ix (m). (n) 11010tal (Privatc/Semi) 1 per 9 1 per 10 33% 1 per 10 1 pee IS (i). (ML W. (p) Nussing Homes (Want) Sink per Floor Malls (Covered) bl 1 pa 750 1 per 1500 50% 1 per 2000 1 pet 20M R (I). (m), (nL (r) Medica[Alealih Cue BuiWint B 1 per 45 1 per 35 30 . 1 per 200 (al, (k), (m), (nL (p) O16ce Budding B 1 per 20 1 per 25 33 G 1 per 50 1 per Floor Retail (Mercantile) • - M I Per 20 1 per 20 31% 1 per 40 (1). (m), W. W Waitinj Rooms (Airports, A 1 pa 55 1 pa 75 "T I per 200 1 per 500 W. (m). (n). (p) Rai" and Bus Stations)) � �i a � - ____ ��-a-s � - lv� � ��-" -- --/-'-�r-'��- . <�� %� �� - v 3 - - � F� �� - _ - ��--` - .�1��-ems'. - >1— -.�_ T. -_ M -1011 _jntemetmisMLS.com - Cape Cod Network Page 1 of 2 SOS- Y17 BILL HARRISON REALTOR Agent: EAN BROWN Phone: (508) 771-7974 Email: jean@harrisonre.com Customer View Cape Cod & Islands Multiple Listing Service - Commercial/Industrial/Business MLS #: 2021774 Status: Active - Cat: Retail LP: $350,000 Address: 311 ROUTE 28 RD t Town: YARMOUTH, MA 7N ZJP: 02673 Unit #: Village: WYA (Click on the Photo to Enlarge) County: BARNSTABLE General Information Zoning: GENERAL BUSINESS 13— Units; I Acres: 0.46 Yr Bit: 1968/ACTUAL Rd Fmtg: Lot Depth: 0 Water Acc: Lot Desc: Cleared, LeJel, Sloping Conf.Use: Y Bus.Operating: N Bus.Name: Parking Spaces: 18 Parking: Paved Drvway Waterfront: N/ Waterview. N/ Beach Desc: None Beach Own: None Beach/Lake/Pond Name: Convenient To: Med Facil, Mir Highway, Shopping Miles to Beach: O-AMI Condo: N Levels: 1 Add.Units: Bus.includes: None Seating Capacity: BIdg.Name: Mall/Park Name BIdg.SgFL: 1400 Association: N Mbrshp Req: U Ann Asc Fee: $0/0 Assoe.Fee Includes: Present Use: Other Retail Structure: Year Estab.• 0 Services: Interior Information Office SgFL: 0 Retail SgFL: 0 Industrial SgFL: 0 Warehouse SgFL: 0 Total Leasable SgFL: 0 Total Leased SgFL• 0 Min SgFootage Avail.: 4 Max SgFootage Avail.: 1 Min Cell HgL: 7'0" Max Cell HgL: 0'0" Basement: Crawl Space Flooring: Interior Features: FluorscntUt, SecureSystem Walls: Paneled Sheet Rock Baths/Lavatories: One http://app4c.capccodmis.net/capecod/mis 7/26/2002 .r• -mctmisMLS.com - Cape Cod Network Page 2 of 2 2021774.311 ROUTE 9A Rn _ YARMOI ITH _ MA Exterior Information Foundation: Block construction: Wood Frame Exterior Features: DisplyWiindow, FluorscntLk, SecureSystem Siding: Other-Remrks Roof: Asphalt, Pitched Mechanical Information - Heating/Cooling: AC -Central, Hot Water, Natural Gas Hot Water. Natural Gas Electric: 100-150 Amps Water. PWtr on Site Sewer. Priv Sewer Gas: On Site Remarks PRIME LOCATION ON BUSY ROUTE 28. WIDE OPEN FLOOR PLAN OFFERS A V ARIETY OF USES. PLENTY OF PARKING, BUILDING ONLY FOR SALE. Legal/Tax Information Imprints Asmt: 40000 Annual Taxes: $1.879.5912002 Title Reference: 12460/29210 Land Assessment: 164400 Annual Betterment: 0 Lead Paint: U Total Asmt 204400 Unpd Bettim: 0 UFFI: N To Be Assessed: U Spec Assessment: U Mass Use: 325 Assessors Map: 30 Assessors Parcel: 26 Undgmd Fuel: U Asbestos: U Doc On File: No Documents Leased: Lease Exp: For Lease: Lse Price Per SgFL: Lease Inc.: For Sale: Type Of Mortgage: First Mortgage Amt: $0 Util Exp: $0 Real Estate Tax Exp: $0 Annual Lease Exp: $0 Insurance Exp: $0 Common Area Maint Exp: $0 Repair/Maint Exp: $0 Mgmt Exp: $0 : $0 Wages: $0 Gross Oper. Inc.: $0 Total Exp: $0 Net Oper.lnc.: $0 Special Financing: Showing: Appntmnt Req, Call Lstg Of. Yard Sign Directions to Property ON ROUTE 28 IN W. YARMOUTH ACROSS FROM FACTORY OUTLETS. IN SAME PARKING LOT AS BAGELS & BEYOND. Printed by BILL HARRISON REALTOR on 2002-07-2612:34:55 PM O Identified agent may not be the listing agent Information herein deemed refiable but not guaranteed. http://app4c.capecodmis.nct/capecod/mis 7/26/2002 LOCATION MAPCA,/,T,S� ASSESSORS MAP: l PARCEL : FLOOD ZONE: REFERENCE: -PEEK # M3�iG�'' �2 /6 t /00� pU i �i t "L i z TEST HOL SOIL EVALUATOR:l _ _WITNESS: DATE: PERCOLATION RAT TH-I LL. %7 � s J �� : 6 Z 15 I►w� l.', A ZOO N lei A0, or Ile OKI -� �� UsJ- rl SEPTI FLOW - S EP T IJ --`a1SE py- SOIL 16 SEP �I e gammanfacult4 of Aassac4usetts #1480 TOWN OF YARMOUTH In accordance with the Massachusetts State Building Code, Section 120.0, this CERTIFICATE OF USE AND OCCUPANCY is issued to GARY HENNESSEY ,1 (Gertif U that 1 have inspected the PREMISES known as CAPE COD TOBACCO located at 311 MAIN ST- RTE. 28 in the TOWN of WEST YAR14OUTII Cbunty of BARNSTABLE Commonwealth of Massachusetts. The building is hereby certified to be in compliance with the Basic Code and for the purpose stated below. USE GROUP M FIRE GRADING 511 APRIL 17. 1998 Date Certificate Issued LIVE LOAD OCCUPANCY LOAD U PERSONS f W Building Official The building official shall be notified of any changes in the above information. TOWN OF YARM 1Ij6l%8 P. APPLICATION FOR USE 0¢�Pi`S�AN DATE: 4` �- q� D 35 $35 .00 APR 211998 IN ACCORDANCE WITH THE PROVISIONS OF THE M SACHUSETTS STAT BUILDING CODE, SECTION 119.0. I HEREBY APPLY FOR A CERTIF %jE OF UaE ANn CCUPANCY FOR THE BELOW NAMED PREMISES, LOCATED AT THE FOLLO G—Al= NAME OF YOUR BUSINESS- EL# ZZL S75% STREET ADDRESS d ZZ 29' (A) !Sr Y Kma.ing <y1r7 15X73 PURPOSE FOR WHICH PREMISES IS USED C�G/�i� C�c4fi�iL,�TlF ?iSsO[rc'a ST11�E CERTIFICATE ISSUED TO HOME ADDRESS:/bZ� /j` SQUARE FOOTAGE TO BE OCCUPIED:Z-3 �U OWNER OF BUILDING: BUILDING OWNER'S ADDRESS: OCE/g71/ �% �- 7%}6kUC1�NTELE: NAME F PRESENT HOLDER OF CERTIFICATE: SIGNATU E OF PERSON TO M CERTIFICATE TITLE IS ISSUED OR HIS AUTHOR ZED AGENT DATE PLEASE NOTE: 1). APPLICATION FORM MUST BE SUBMITTED FOR EACH BUILDING OR STRUCTURE OR PART THEREOF TO BE CERTIFIED. 2). APPLICATION AND FEE MUST BE RECEIVED BEFORE THE CERTIFICATE WILL BE ISSUED. 3). THE BUILDING OFFICAL SHALL BE NOTIFIED WITHIN TEN (10) DAYS OF ANY CHANGE IN THE ABOVE INFORMATION. CERTIFICATE NUMBER J'/ -o I !F 9 As A-P /Let 4/14/9ps&,-, Ja The Commonwealth of Massachusetts Department of Industrial Accidents 011led ollaresllpst/iss 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Cll) Lt iPAT Vet UEOt/T/1 phone a 28'- 0 1 am a homeowner performing all work myself. 15( I am a sole proprietor and have no one working in any capacity 0 1 am an employer pro%iding workers' compensation for my employees working on this job. company name: address: cat)•• phone ft: insurance co policy ff 0 I am a sole proprietor. general contractor. or homeowner (circle one) and have hired the contractors listed below who have the follow ing %%orkers' compensation polices: Failure to secure coverage as required under Section 25A of MGL 152 tan lead to the imposition of crimlaal penalties of a Dne op to S1,MAO and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Dee of SI00.00 a day against me. I naderstand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certij nder the pains and penalties of perjury that the information provided above is true �and correm Signature ate Print name �rf9 D • /1/.r(� Et/ Phone M( —2 official use only do not write in this area to be completed by city or town official city or town: YARHODTR ❑ check if immediate response is required permitAicense 0 nBuilding Department ❑Licensing Board 261 ❑Selectmen's Office rno% 398-2231 ❑eealth Department phone #; _ % — _ ext - rlOther contact person: Poised 3.95 PJA1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their entplo%ees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied. oral or written. An enrployer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the forcuoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the o%%tier of a dwelling house having not more than three apartments and who resides therein, or the occupant of the d%%ellin= house of another %%ho employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. %lGI_ chapter 152 section also states that every state or local licensing agency shall withhold the issuance or renc%val of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionall%. neither the commom%ealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha%e been presented to the contracting authority. Applicants Please till in the workers' compensation affidavit completely, by checking the box that applies to your situation and supph_ing company_nantes_address and phone numbers as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial accidents. Should you have any questions regarding the "law" or if you are required to obtain a workers' compensation policy. please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retuned to the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents once of ltlne3911Ue13 600 Washington Street Boston Ma. 02111 fax 0: (617) 727-7749 phone 9: (617) 7274900 ext. 406, 409 or 375 l( is issued to (Z49 90MMOnfMlth of MUSS'aC4USMS #687 TOWN OF YARMOUTH In accordance with the Massachusetts State Building Code, Section 120.0. this CERTIFICATE OF USE AND OCCUPANCY THE PELiA WIN" STORE e. P (9ert if U,that l have inspected the P10"ISES known as THE PELLA WINDOW STORE located at 311 ROME 28 to the TOWN of WEST YAFddOiTTii Cbunty of BARNSTABLE Cbmmonwealth ojMassachusetts. The building is hereby certified to be in compliance with the Basic Cbde and for the purpose stated below. USE GROUP _ FIRE GRADING F-bniazZy 94, 1988 Dale Certificate Issued LIVE LOAD _ OCCUPANCY Building Official The building official shall be notified of any changes in the above information. • QMCMEALTH OF ' t CITY/TOWN OF APPLICATION FOR USE DATE Z- 4 - ?'E 2 4 La cKF6--1 y/iifa ( ) FEE REQUIRED $% IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, SECTION 108.15, I HEREBY APPLY FOR A CERTIFICATE OF USE AND OCCUPANCY FOR THE BELOW NAMED PREMISES, LOCATED AT THE FOLLOWING ADDRESS: NAmE OF • •ro : tia. . r STREET AND NUMBER i . • PURPOSE FOR VALICH • •m : tea. IS USED LICENSE (S• • • a•.: RHQUIRED FOR THE •Ra : tia. BY OTHER GO%MHMlrAL AG24CIES: CERTIFICATE TO BE ISSUED Ta ADDRESS: A t (1-Pt>r_T D A F�A L-L, Q-10C(L MA TEL# SQUARE FOOTAGE TO BE OCCUPIED: OWNER OF RECORD OF BUILDING: NAME OF PRESENT HOLDER OF CERTIFICATE: L)4 i 't5 lz� o J E' 1 nJ -rrcL n1 A -,-z o rJ ^A V NAME OF AGENT, IF ANY: SION1T[JRE OF GMSON TO WHOM CERTIFICATE TITLE IS ISSUED OR HIS AUTHORI=D AGENT y - 1 : - 8F( DATE PLEASE NOTE: 1.) APPLICATION FORM MUST BE SUBMITTED FOR EACH BUILDING OR STRUCTURE OR PART THEREOF TO BE CERTIFIED. 2.) APPLICATION AND FEE MUST BE RECEIVED BEFORE THE CERTIFICATE WILL BE ISSUED. 3.) THE BUILDING OFFICAL SHALL BE NOTIFIED WITHIN TEN (10) DAYS OF ANY CHANCE IN THE ABOVE INFORMATION. CERTIFICATE NO. 4al / ! � 3 91 APPPLICATION FOR ANNUAL SIGN PERMIT Date: 9/27/00 Renewal Fee: $10�010. or) Payable upon receipt Permit No: 2917 Sign Type: Free Standing Permit Issued: 5/19/98 10 Permit Expires: 5/19/00 L D� F In accordance with the provisions of the Town of Yarmouth Zoning By-law 303.6.5 amended September 14, 1987,1 hereby apply for a permit for the below named sign, located at the following address: Business: Cape Cod Tobacco Location: 311 Route 28, WY Square footage of sign: 4'W X 4'H 44ki- WMjV----- Signature of person, or authorized agent, to whom permit is to be granted. 0 (9w ij eNr Title ,_ fo -3-aa Date Please note: 1) Application form must be submitted for each permanent sign. 2) Application and fee must be received before the permit is granted. 3) The building official shall be notified within ten (10) days of any change in the above information. Transfer of permit is not allowed. TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.267 September 27,2000 Business Owner, Manager or Responsible Party; Your business has been issued a permit for a sign as indicated on the enclosed renewal Application. At the anniversary date of that sign permit a renewal application was mailed to you. This renewal form has not been returned with the $10.00 fee, as required. Each year we send out these renewal forms as required by section 303.6.5 of the Town of Yarmouth Zoning Sign Code , and their return indicates to us which signs are still active and which are no longer Desired by the owners. Section 303.8.3 of that same code requires us to have all abandoned signs removed within 30 days Of the time that they are deternvned to be abandoned. Please help me to determine the status of your sign by checking one of the following and returning This form to the Yarmouth Building Dept, at 1146 Route 28, South Yarmouth , MA 02664 This application has been sent the wrong address (please correct) L//1 wish to renew this permit and have enclosed the form & fee I do not choose to renew the permit and will remove the sign within 30 days I am no longer involved with this sign THIS IS FOR THE SIGN PERMIT # 1 o-D Signature of the Owner or Other B2 B3 RES lr- TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 260 APPLICATION TO ERECT AND MAINTAIN SIGN SIGN PERMIT # APPROVED MAP () LOT q -�— ••-n��'L , , • DATE__ TO THE SIGN--INSPECTOR:-UNDER SECTION 303 OF THE YARMOUTH BY-LAWS, THE UNDERSIGNED HEREBY APPLIES FOR A SIGN PERMIT ACCORDING TO THE FOLLOWING INFORMAITION: BUSINESS NAME (a �u n ]` d�id;a�rh, �l3/ �� h4� �r/S �►,4 �,rslrEL c308 77/ 7 9 q f LOCATION/ADDRESS_ 3// R6C28 ZONING DISTRICT B1 BUSINESS OWNER A6 ran k - BUILDING OWNER MST. DIST TEL__ f4L 77), 797�( TEL TYPE OF CONSTRUCTION P/e y/4 /4 s WLIGHTING V,.a TYPE__ FREE STANDING ATTACHED_ TEMPORARY_ -SUBDIVISION -MUNICIPAL_ DIAGRAM OF LOT AND SIGN WITH DIMENSIONS AND SET -RACKS FROM PROPERTY LINESTHAT TAT ARE AT LEAST 6 FELT PER CODE, AND WHERE ATTACHEDSHOW IOW RUNNING FOOTAGE OF PORTION OF FRONTAGE OCCUPIED BY BUSINESS. J4 Wf FOR sALC- �7„ J (3iwF{rla,z��1 771 7y 74 bovb/e Aee U�iht •64cky�o�nc/ RF4 eopw, 0 0 pd� Ill JUL -1 2 2002 111L•REBYAGREETOCONFORM TOTHEZONINGBY-LAWS,SECTION303OFTHETOWNOFYARMOUTH REGARDIN -0— SIGN CONSTRUCTION. I FURTHER AGREE TINT THIS SIGN WILL NOT BE ALTERED, ADDED TO, OR CI IANGED W ANY WAY UNTIL A NEW PERMIT HAS BEEN GRANTED, THE NUMBER OF THIS PERMIT WILL BE AFFIXED TO TILE SIGN IN NO LESS TI[AN '/." NUMBERS. ALL PERMITS ARE SUBJECT TO THE APPROVAL OF THE SIGN INSPECTOR. THIS PERMIT REP cES it 31-1o2y NAMEV6,uy APPROVAL BY DATE X : _ PEE S i FOR SAW � lA��D AlILL HARRl5011 gEA=R3 . '7 os 7'1497a TOWN OF YAi! iN UTH BUILDING DEi'ArThkENT 1146 Route 28, South Yari000th; MA 02664 508-398-2231 ext.1261, �,;aic 508-398-0836 ZONING DETERMINATION FOR BUSINESS CERTIFICATE r MAR 10 2010 Fpr The purpose of this form is to determine whether your business complies with the Town of Yarmouth Zoning Bylaw. The applicant shall complete the top section of this form and file it with the Building Department. Once the Building Department has made a determination, it will be forwarded to the Town Clerk. The Building Department will render a determination based nn the following factors: (a) The business/use, activity, (b) The zoning district in which the business is to be locales :'AUowed uses are based on Zoning Bylaw Table 202.5 and (c) Previous or new zoning relief from the Za ciug. &grd of Appeals Date ��1�� 10 S�—� �--7 Z Business Address "-",I I MA1,A V CDV s 1-- Name of Applicant_ ( 13.y2 Va 1 ho Mailing [:l Description of Business Activity The applicant acknowledges that a determination will be made by the Building Department based on the information provided on this date and any changes in the business use and/or activity will require additional approval. Failure to do so may result in the revocation of the Business Certificate and/or appropriate Zoning Enforcement, should it be determined that the changes are non -compliant. 's BUILDING DEPARTMENT DE'I'"1--y." NATION (office use only) Approved Comments Disapproved Reason for Disapproval Building Official's Signature ` 0 C PP TOWN OF YARMOUTH An•,y BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 exL 1261 SIGN P �tiIIT-�iPPLICATION Date 5iL•AT 7 2012- LSEP 24 2012 Permit No. - 3 Applicant Instructions HTf.I-lvr 1) Applicant shall complete both sides of application. 2) One application form is required for each sign. Each sign will be assigned its own permit number. 3) Applicant shall attach separate 8 Ws L I I" sheets including the following diagrams: A) Design, dimensions and colors of the proposed sign B) Freestanding Signs: provide certified plot plan with location of the proposed sign, including setbacks from property lines. A stamped "as -built' will be required before the permit can be issued C) Attached Signs: show length-0 portion of building frontage that is occupied by applicant. D) Temporary Signs: location on sign A96 /A21'1�Ot7Tf% Address of proposed sign Historic District Name of Business for propo gn _ a & F L 3+ F-YO N I Name of Business owner 0 L t E )V1. 0 R 4h1 Mailing Address of Business owner 3 11 ' M 4 I ya 57 C)Z T ZSl t-o . -/ g rLrnO OT H Business Owner Phone: Business 50'9- 7 9 0— S S 00 Home Name of Building Owner gyj:SO N G tL o" la Phone 508 - Z Loi - -(� 1 Z PExe iz SigaBuilde;TVTeDS GP-4 f)4)C•S( Tray-ACIRloy-iignMataials L s-rl(_ Sign Builder Address 90( CZII 1I S LAM PIF 1ST R-I Phone �LQF-ZFO - y7Vo Singly Occupied Building >3usiness Center Internal Light—�temal Light Freestanding Sin Size: ti 0, i 2,' C,St9 t\l k"- Cf-5 St% -P Awt W f �Y -MOG K) Attached Sign Size: Tem»orary Sion Size: Dates: Please Complete other side of Sign Permit Applicagoq E C l `� - ' 2 6 2012 i cTJ•,�i�=�'�� er . All Permits are subiect to the approval of the Sign Inspector I hereby agree to conform to the provisions of Town of Yarmouth Zoning By-law Section 303 governing sign construction and installation. I further agree that this sign will not be altered, added to or changed in any way unless a new permit has been issued. Sign Permits are not valid until the Building Commissioner issues Use and Occupancy Permits (where applicable). Signature of Property Owner Authorization: I sign application. Approved by: Date r:� 2D12— the applicant to act on my behalf in all matters related to this With the following conditions: I have read and understood the conditions of this Sign Permit listed above: Date b 12 Date %' Zr/Z., 'Box SIZE : 4z X 72 pi P F. Sox : 6 It X y $O (M) vwys s $��o � d W HOREIIA➢E BAGELS BREAKFAST•LONCIi changeable section i IASAIC09Cult, niw t N sTAwED o"i mallNAt, "PIPE SA"F. Lemr.^riah)i phone: 508-896-084 cell: 508-280-4786 e-mail www.petrosgraphics@yahGo.com 3/17/2015 SIIpGen- Portal Home Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time Town of Yarmouth Template [Building Dept] tEN :■ Slipshect IdcntiCcr [sg22649] Building Permits 030.26 0311 ROUTE 28 Building 3724 No Operator, Yarmscan 2015-03-17 - 14:07 httpJnaserfiche171SIIpGerV 1/1